Individual
MARY E. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 528-5261
(317) 528-5026
Mailing address
PO BOX 7112, DEPT. #31, INDIANAPOLIS, IN 46207-7112
(317) 802-3151
(317) 870-0499
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001218
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200035470
—
IN
Enumeration date
08/16/2006
Last updated
04/01/2021
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