Provider Demographics
NPI:1235970153
Name:JOHNSON, HOLLIE ANN
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4880 OLD AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4456
Mailing Address - Country:US
Mailing Address - Phone:907-313-1333
Mailing Address - Fax:
Practice Address - Street 1:4880 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4456
Practice Address - Country:US
Practice Address - Phone:907-313-1333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist