Provider Demographics
NPI:1699744045
Name:JOHNSON, JENNIFER A (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4189 WESTLAWN S
Mailing Address - Street 2:STUDENT HEALTH & WELLNESS
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1100
Mailing Address - Country:US
Mailing Address - Phone:319-335-8370
Mailing Address - Fax:319-335-7247
Practice Address - Street 1:4189 WESTLAWN S
Practice Address - Street 2:STUDENT HEALTH & WELLNESS
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1100
Practice Address - Country:US
Practice Address - Phone:319-335-8370
Practice Address - Fax:319-335-7247
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073909207Q00000X
IA41212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4514899Medicaid
0803901061OtherBCBS
M97260017Medicare ID - Type Unspecified
H86643Medicare UPIN