Provider Demographics
NPI:1902531601
Name:JOHNSON, EMILIE J (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:EMILIE
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10754 S RIPPLING BAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-5152
Mailing Address - Country:US
Mailing Address - Phone:801-651-1645
Mailing Address - Fax:
Practice Address - Street 1:1478 EAST HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534
Practice Address - Country:US
Practice Address - Phone:435-678-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT280070-4405363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care