Provider Demographics
NPI:1487422358
Name:JOHNSON, SANDRA LOWE (APRN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LOWE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4254 S 2450 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2053
Mailing Address - Country:US
Mailing Address - Phone:801-388-8086
Mailing Address - Fax:
Practice Address - Street 1:4254 S 2450 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2053
Practice Address - Country:US
Practice Address - Phone:801-388-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7982504-4405363LF0000X
UT7982504-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily