Individual
MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
550 S HOKE AVE, FRANKFORT, IN 46041-2664
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
209007298
IL
363LF0000X
Family Nurse Practitioner
Primary
71002947A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000993545
ANTHEM PROVIDED NUMBER
IN
05
—
200978810
—
IN
Enumeration date
11/03/2008
Last updated
08/10/2016
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