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NPI Code Detail

MEDICARE: JENNIFER M JOHNS CST

MEDICARE: JENNIFER M JOHNS CST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1246ZS0410XSurgical Technologist123994IN

General Provider Information

NPI Number : 1821377052
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M JOHNS CST
Provider Business Mailing Address
First Line : PO BOX 4699
Second Line :
City : LAFAYETTE
State : IN
Zip : 47903-4699
Country : US
Telephone Number : 765-449-2732
Fax Number : 765-446-5317
Provider Business Practice Location Address
First Line : 3774 BAYLEY DR
Second Line : SUITE B
City : LAFAYETTE
State : IN
Zip : 47905-8651
Country : US
Telephone Number : 765-807-2280
Fax Number : 765-807-2281
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2011
Last Update Date : 08/05/2011

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Directions to “ JENNIFER M JOHNS CST” Practice Location

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