Provider Demographics
NPI:1912069121
Name:JOHNSON, ELISABETH A (FNP-BC, PHD)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP-BC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - Street 2:UNC CB # 7570
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7570
Mailing Address - Country:US
Mailing Address - Phone:919-966-9803
Mailing Address - Fax:919-966-9169
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-4220
Practice Address - Country:US
Practice Address - Phone:919-843-1592
Practice Address - Fax:919-966-9169
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117749NP363LF0000X
NC5004071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily