Provider Demographics
NPI:1609684786
Name:JOHNSON, MADDISON PAIGE (PA)
Entity type:Individual
Prefix:
First Name:MADDISON
Middle Name:PAIGE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FAWN PARK DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-8677
Mailing Address - Country:US
Mailing Address - Phone:785-342-6221
Mailing Address - Fax:
Practice Address - Street 1:111 FAWN PARK DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-8677
Practice Address - Country:US
Practice Address - Phone:785-342-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant