Provider Demographics
NPI:1871512665
Name:JOHNSON, DEBORAH ANN (WHNP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9423
Mailing Address - Country:US
Mailing Address - Phone:919-735-3464
Mailing Address - Fax:919-735-0080
Practice Address - Street 1:2608 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9423
Practice Address - Country:US
Practice Address - Phone:919-735-3464
Practice Address - Fax:919-735-0080
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800147363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC800147OtherNCMB LICENSE NUMBER
NC7003760Medicaid