Individual
EDALYN KAY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4550 EUBANK BLVD NE, SUITE 105, ALBUQUERQUE, NM 87111-3479
(505) 296-1120
(505) 296-1121
Mailing address
4550 EUBANK BLVD NE, SUITE 105, ALBUQUERQUE, NM 87111-3479
(505) 296-1120
(505) 296-1121
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R17788
NM
363L00000X
Nurse Practitioner
Primary
R17788
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
743032990
TRIWEST
NM
Enumeration date
05/05/2006
Last updated
05/20/2008
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