NPI 1033414248

Nicole Marie Johnson, PAC

Practitioner Physician Assistant Midvale, UT

Practice location

Address: 7302 S Bingham Junction Blvd, Midvale, UT 84047-4804
Phone: (801) 442-5502
Mailing address: PO Box 27128, Salt Lake City, UT 84127-0128

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 8975784-1206 (UT)

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Registry record

NPI: 1033414248
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Jan 2011
Record last updated: 23 Jun 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.