Provider Demographics
NPI:1700617560
Name:JOHNSON, NANCY CAROLINA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:CAROLINA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 S BOULDER HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-8533
Mailing Address - Country:US
Mailing Address - Phone:702-791-9030
Mailing Address - Fax:
Practice Address - Street 1:1020 S BOULDER HWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-8533
Practice Address - Country:US
Practice Address - Phone:702-791-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821980390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program