Provider Demographics
NPI:1285738385
Name:JOHNSON, MARY ELIZABETH (CRNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 DUNCAN LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-1678
Mailing Address - Country:US
Mailing Address - Phone:412-881-6663
Mailing Address - Fax:
Practice Address - Street 1:VA PITTSBURGH HEALTH CARE SYSTEM UNIVERSITY DRIVE C,
Practice Address - Street 2:111C
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15240-1001
Practice Address - Country:US
Practice Address - Phone:412-688-6176
Practice Address - Fax:412-688-6904
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP003837M363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care