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Individual

MR. BRIAN ROBERT JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
N.P.

Contact information

Practice address
1350 PARKWAY DR, BLACKFOOT, ID 83221-1657
(208) 782-2415
(208) 782-2411
Mailing address
98 POPLAR ST, BLACKFOOT, ID 83221-1758
(208) 785-4100
(208) 785-8529

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP-1550A
ID

Other

Enumeration date
03/17/2015
Last updated
05/06/2016
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