Provider Demographics
NPI:1457551392
Name:JOHNSON-WIRT, AIMEE D (MD)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:D
Last Name:JOHNSON-WIRT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-463-5600
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:2405 RESEARCH PARKWAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-522-1134
Practice Address - Fax:719-268-2819
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0055826208000000X
AL29019174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics