Provider Demographics
NPI:1306091731
Name:JOHNSON, ADRIAN ELISE (PA)
Entity type:Individual
Prefix:MRS
First Name:ADRIAN
Middle Name:ELISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:275 S. ASPEN ST, STOP 89; BUCKLEY AFB
Mailing Address - Street 2:460 MDOS/SGOP
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-9547
Mailing Address - Country:US
Mailing Address - Phone:720-847-6055
Mailing Address - Fax:720-847-6494
Practice Address - Street 1:830 POTOMAC CIRCLE, 4TH FLOOR
Practice Address - Street 2:460 MDOS/SGOP
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010
Practice Address - Country:US
Practice Address - Phone:720-847-6055
Practice Address - Fax:720-847-6494
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant