Individual
MARTY J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
185 S 400 E STE 100, BOUNTIFUL, UT 84010-4862
(801) 475-3482
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 475-3500
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
11099893-4405
UT
363LF0000X
Family Nurse Practitioner
11099893-4405
UT
Other
Enumeration date
02/22/2024
Last updated
04/22/2024
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