Individual
MARY I JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
115 BUSINESS LOOP 70 W, COLUMBIA, MO 65203-3244
(573) 882-4979
(573) 884-6050
Mailing address
PO BOX 7687, COLUMBIA, MO 65205-7687
(573) 882-2259
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
048830
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101660
HEALTHLINK
MO
01
—
143538
BLUE SHIELD/BLUE CHOICE
MO
05
—
425336609
—
MO
Enumeration date
06/01/2006
Last updated
08/09/2012
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