Provider Demographics
NPI:1184050460
Name:JOHNSON, AMANDA JOY (MSN)
Entity type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:JOY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:MS
Other - First Name:AMANDA
Other - Middle Name:JOY
Other - Last Name:LASLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:1500 GALEN ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4913
Mailing Address - Country:US
Mailing Address - Phone:202-610-7160
Mailing Address - Fax:202-610-7164
Practice Address - Street 1:1992 LANCASHIRE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-6174
Practice Address - Country:US
Practice Address - Phone:404-213-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1029945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily