Provider Demographics
NPI:1790673093
Name:JOHNSON, MICHELLE PAULINE (BSN, RN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PAULINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 W 975 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-8826
Mailing Address - Country:US
Mailing Address - Phone:945-546-2710
Mailing Address - Fax:
Practice Address - Street 1:2458 W 975 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-8826
Practice Address - Country:US
Practice Address - Phone:945-546-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308013-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse