Provider Demographics
NPI:1871649723
Name:JOHNSON, DONNA GUYOT
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GUYOT
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 1:15301 TYLER FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9318
Mailing Address - Country:US
Mailing Address - Phone:530-272-7856
Mailing Address - Fax:530-272-7856
Practice Address - Street 1:15301 TYLER FOOTE RD STE 115
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2319106H00000X
CA39940106H00000X
WA162924163W00000X
CA329150363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163W00000XNursing Service ProvidersRegistered Nurse