Provider Demographics
NPI:1306076450
Name:JOHNSON, SANDRA J (FNP-C)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4022 STIRRUP CREEK DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9411
Mailing Address - Country:US
Mailing Address - Phone:919-425-3000
Mailing Address - Fax:919-425-3001
Practice Address - Street 1:4022 STIRRUP CREEK DR
Practice Address - Street 2:SUITE 315
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-9411
Practice Address - Country:US
Practice Address - Phone:919-425-3000
Practice Address - Fax:919-425-3001
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004442363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2594328Medicare PIN