Provider Demographics
NPI:1699102285
Name:JOHANNES, ANGELA ROSE (CRNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ROSE
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23135 FOXGLOVE WAY
Mailing Address - Street 2:
Mailing Address - City:CALIFORNIA
Mailing Address - State:MD
Mailing Address - Zip Code:20619
Mailing Address - Country:US
Mailing Address - Phone:301-880-6210
Mailing Address - Fax:
Practice Address - Street 1:37767 MARKET DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3188
Practice Address - Country:US
Practice Address - Phone:301-884-0278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily