Basic Information
| Provider Information | |||||||||
| NPI: | 1144508466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ANGEL | ||||||||
| MiddleName: | MADOLID | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ANP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHNSON | ||||||||
| OtherFirstName: | ANGEL | ||||||||
| OtherMiddleName: | MADOLID | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | ANP-BC | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12361 W BOLA DR | ||||||||
| Address2: | STE 109 | ||||||||
| City: | SURPRISE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853789021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232271000 | ||||||||
| FaxNumber: | 6232272000 | ||||||||
| Practice Location | |||||||||
| Address1: | 17218 N 72ND DR | ||||||||
| Address2: | SUITE #100 | ||||||||
| City: | GLENDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853088580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233348670 | ||||||||
| FaxNumber: | 6233348675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2011 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | AP4112 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.