Provider Demographics
NPI:1316958606
Name:JOHNSON, SUSAN F (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BOULEVARD
Mailing Address - Street 2:301 UNIVERSITY BLVD RT. 0479
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-0479
Mailing Address - Country:US
Mailing Address - Phone:409-772-1430
Mailing Address - Fax:409-772-6833
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:ROUTE 0479
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-5302
Practice Address - Country:US
Practice Address - Phone:409-772-1430
Practice Address - Fax:409-772-6833
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232242363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155953602Medicaid
TX8N3649OtherBLUE CROSS BLUE SHIELD
TX155953602Medicaid
TX8A3397Medicare ID - Type Unspecified