Provider Demographics
NPI:1730176520
Name:JOHNSON, DONNA (BSN,MS,CRNP)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSN,MS,CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26840 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1409
Mailing Address - Country:US
Mailing Address - Phone:301-475-8091
Mailing Address - Fax:301-475-6712
Practice Address - Street 1:26840 POINT LOOKOUT RD
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-1409
Practice Address - Country:US
Practice Address - Phone:301-475-8091
Practice Address - Fax:301-475-6712
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR082022363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
S84053Medicare UPIN
MD145344ZCS8Medicare PIN