Provider Demographics
NPI:1144473463
Name:JOHNSON, LORI FRIEDRICH (NP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:FRIEDRICH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 LOMBARDI CT # B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6793
Mailing Address - Country:US
Mailing Address - Phone:707-547-2220
Mailing Address - Fax:707-547-2229
Practice Address - Street 1:751 LOMBARDI CT # B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6793
Practice Address - Country:US
Practice Address - Phone:707-547-2220
Practice Address - Fax:707-547-2229
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP18497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily