Provider Demographics
NPI:1508844861
Name:JOHNSON, ELTON EDWARD JR (APRN)
Entity type:Individual
Prefix:MR
First Name:ELTON
Middle Name:EDWARD
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:98-139 KANUKU ST
Mailing Address - Street 2:APT 109
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5123
Mailing Address - Country:US
Mailing Address - Phone:808-488-1237
Mailing Address - Fax:
Practice Address - Street 1:400 SAND ISLAND PKWY
Practice Address - Street 2:USCG
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4326
Practice Address - Country:US
Practice Address - Phone:808-842-2930
Practice Address - Fax:808-832-3281
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2025-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX583059163WG0000X
HI45098163WP2201X
TX69774164X00000X
HI675363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily