Individual
NICOLE ELISABETH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2820 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-5462
(605) 342-3280
Mailing address
2820 MOUNT RUSHMORE RD, RAPID CITY, SD 57701-5462
(605) 342-9280
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CP000607
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP000607
LICENSE
SD
Enumeration date
08/24/2010
Last updated
09/16/2011
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