Provider Demographics
NPI:1760824353
Name:JOHNSON, NATALIE MA (NP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:MA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2880 ATLANTIC AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1714
Mailing Address - Country:US
Mailing Address - Phone:562-492-9900
Mailing Address - Fax:562-492-9902
Practice Address - Street 1:2880 ATLANTIC AVE STE 170
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1714
Practice Address - Country:US
Practice Address - Phone:562-492-9900
Practice Address - Fax:562-492-9902
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA742347163W00000X
CA22866363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043640063OtherCARDIN HEALTHCARE
CA22866OtherCALIFORNIA STATE NURSE PRACTITIONER LICENSE