Provider Demographics
NPI:1285733899
Name:JOHANNSEN, JANE MARGARET (CNP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARGARET
Last Name:JOHANNSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13810 BUTLER ROAD
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-9026
Mailing Address - Country:US
Mailing Address - Phone:440-965-5601
Mailing Address - Fax:
Practice Address - Street 1:630 EAST RIVER STREET
Practice Address - Street 2:EMH REGIONAL MEDICAL CENTER
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035
Practice Address - Country:US
Practice Address - Phone:440-326-5471
Practice Address - Fax:440-329-7711
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN096227163W00000X
OHNP00166363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2347240Medicaid