Provider Demographics
NPI:1194972182
Name:JOHNSON, CHRISTINE DONNA (ANP BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:DONNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP BC
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Other - Credentials:
Mailing Address - Street 1:3100 SCHOFIELD RD
Mailing Address - Street 2:BLDG 1179
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7577
Mailing Address - Country:US
Mailing Address - Phone:210-916-3160
Mailing Address - Fax:210-808-2345
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS/ADOLESCENT MEDICINE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-3160
Practice Address - Fax:210-808-2345
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR123606363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR123606OtherNURSING LICENSE