Provider Demographics
NPI:1447841069
Name:JOHNSON, EMILY SOO (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SOO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SOO
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 S 17TH ST STE 310
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3700
Mailing Address - Country:US
Mailing Address - Phone:402-483-8555
Mailing Address - Fax:
Practice Address - Street 1:2221 S 17TH ST STE 310
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3700
Practice Address - Country:US
Practice Address - Phone:402-483-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant