Provider Demographics
NPI:1386938017
Name:JOHNSON, NORAH (PHD RN CPNP)
Entity type:Individual
Prefix:DR
First Name:NORAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD RN CPNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1834 W WISCONSIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2125
Mailing Address - Country:US
Mailing Address - Phone:414-933-9100
Mailing Address - Fax:414-933-9200
Practice Address - Street 1:1834 W WISCONSIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2125
Practice Address - Country:US
Practice Address - Phone:414-933-9100
Practice Address - Fax:414-933-9200
Is Sole Proprietor?:No
Enumeration Date:2011-05-28
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1928-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43945600Medicaid