Individual
MICHAEL J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1026 A AVE NE, CEDAR RAPIDS, IA 52402-5036
(319) 369-7959
Mailing address
2826 W LOCUST ST, DAVENPORT, IA 52804-3354
(563) 332-8528
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209009740
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
G094270
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G094270
ARNP LICENSE
IA
Enumeration date
08/31/2012
Last updated
09/29/2020
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