Provider Demographics
NPI:1215136817
Name:JOHANSON, RACHEL (CNM, WHNP, FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:CNM, WHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 TOLL GATE RD
Mailing Address - Street 2:PRC AND CREDENTIALING
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2759
Mailing Address - Country:US
Mailing Address - Phone:401-273-0641
Mailing Address - Fax:401-273-2919
Practice Address - Street 1:1195 NORTH MAIN STREET
Practice Address - Street 2:CNEMG PRIMARY CARE WMC
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-0288
Practice Address - Country:US
Practice Address - Phone:401-736-4562
Practice Address - Fax:401-921-9864
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00984363LW0102X, 363LF0000X
RICNM00158367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife