Individual
DR. NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1650 COCHRANE CIR, BLDG 7503, FORT CARSON, CO 80913
(719) 524-4068
Mailing address
101 MISSION ST STE 800, SAN FRANCISCO, CA 94105-1744
(800) 221-5140
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
45635
AZ
207Q00000X
Family Medicine Physician
Primary
DR.0054891
CO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45635
STATE MEDICAL LICENSE
AZ
05
—
55533345
—
CO
01
—
A126391
STATE LICENSE
CA
01
—
DR.0054891
STATE LICENSE
CO
Enumeration date
06/02/2010
Last updated
06/28/2024
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