Provider Demographics
NPI:1124279633
Name:JOHNSON, VONNIE JEAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:VONNIE
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12041 40TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-9676
Mailing Address - Country:US
Mailing Address - Phone:701-842-2055
Mailing Address - Fax:701-842-2433
Practice Address - Street 1:615 6TH ST SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4444
Practice Address - Country:US
Practice Address - Phone:701-628-2505
Practice Address - Fax:701-628-3274
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR14983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily