Individual
SAMUEL PENNINGTON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(801) 499-1889
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(801) 499-1889
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
4471358
ID
Other
Enumeration date
05/12/2025
Last updated
05/12/2025
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