Individual
MISS NICOLE MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7302 S BINGHAM JUNCTION BLVD, MIDVALE, UT 84047-4804
(801) 442-5502
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 442-5502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8975784-1206
UT
Other
Enumeration date
01/19/2011
Last updated
06/23/2020
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