1033107891 NPI number — JANE MARGUERITE JOHNSON FNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033107891 NPI number — JANE MARGUERITE JOHNSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JANE
Provider Middle Name:
MARGUERITE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
JANE
Provider Other Middle Name:
MARGUERITE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1033107891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4974 N FRESNO ST
Provider Second Line Business Mailing Address:
SUITE 526
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93726-0317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-325-2764
Provider Business Mailing Address Fax Number:
559-325-2764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2755 HERNDON AVE
Provider Second Line Business Practice Location Address:
CLOVIS COMMUNITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
CLOVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-638-2252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ZZZ24398Z , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)