Provider Demographics
NPI:1215962428
Name:MEEHAN, JOHANNA L (APRN)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:L
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BRAEMAR DR
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-1614
Mailing Address - Country:US
Mailing Address - Phone:203-271-1389
Mailing Address - Fax:860-496-4951
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:CANCER CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-5554
Practice Address - Fax:860-714-8047
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000843364SX0200X
CT843363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4190435Medicaid
CT000843OtherAPRN
CT21885OtherCT CONTROLLED SUBSTANCE
CTR39729OtherRN LICENSE
CTR39729OtherRN LICENSE
MM0534001OtherDEA
CT21885OtherCT CONTROLLED SUBSTANCE