Johnson, Nicole
Johnson, Nicole is an individual health care provider with primary practice located at 1650 Cochrane Cir Bldg 7503, Fort Carson CO 80913. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Johnson, Nicole can be contacted via phone (719) 524-4068.Contact Information
Primary practice address
1650 Cochrane Cir Bldg 7503
Fort Carson CO 80913
Phone: (719) 524-4068
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Student, Health Care / Student in an Organized Health Care Education/Training Program | 390200000X | ||
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 45635 | Arizona |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | DR.0054891 | Colorado |
Profile Details
| NPI number | 1710207634 |
|---|---|
| LBN Legal business name | Johnson, Nicole |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 2nd, 2010 |
| Last updated | Jun 28th, 2024 - about 5 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710207634 | NPPES |
| Arizona | Other | 45635 | STATE MEDICAL LICENSE |
| Arizona | MEDICAID | 55533345 | STATE MEDICAL LICENSE |
| Arizona | Other | A126391 | STATE MEDICAL LICENSE |
| Arizona | Other | DR.0054891 | STATE MEDICAL LICENSE |
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