Provider Demographics
NPI:1235575788
Name:JOHNSON, ADRIENNE JANE (ANP,FNP-BC,APRN, MSN)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP,FNP-BC,APRN, MSN
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:JANE
Other - Last Name:DAHLGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5598 KENAI FJORDS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4047
Mailing Address - Country:US
Mailing Address - Phone:907-952-2296
Mailing Address - Fax:907-921-5151
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR STE 240
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2970
Practice Address - Country:US
Practice Address - Phone:907-290-4666
Practice Address - Fax:907-921-5151
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1584108Medicaid