Provider Demographics
NPI:1154560621
Name:JOHNSON, SARAH REBECCA (RN, AOCNP, MSN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:REBECCA
Last Name:JOHNSON
Suffix:
Gender:
Credentials:RN, AOCNP, MSN, NP-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:REBECCA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, AOCNP, MSN, NP-C
Mailing Address - Street 1:PO BOX 75216
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-0216
Mailing Address - Country:US
Mailing Address - Phone:336-277-8800
Mailing Address - Fax:336-277-8850
Practice Address - Street 1:2400 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1109
Practice Address - Country:US
Practice Address - Phone:336-832-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181288363L00000X
NC5004304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004867Medicaid
NCNC8636BMedicare PIN