Provider Demographics
NPI:1245129667
Name:JOHNSON, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
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:PO BOX 85
Mailing Address - Street 2:
Mailing Address - City:OAK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84649-0085
Mailing Address - Country:US
Mailing Address - Phone:435-864-7485
Mailing Address - Fax:
Practice Address - Street 1:265 ANDERSON LANE
Practice Address - Street 2:
Practice Address - City:OAK CITY
Practice Address - State:UT
Practice Address - Zip Code:84649
Practice Address - Country:US
Practice Address - Phone:435-864-7485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14211683-3102163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical