Healthcare Provider Details

I. General information

NPI: 1689097461
Provider Name (Legal Business Name): ELOISE JOHNNS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 S C ST
OXNARD CA
93033-3560
US

IV. Provider business mailing address

PO BOX 14
LACLEDE ID
83841-0014
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-6713
  • Fax:
Mailing address:
  • Phone: 509-344-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60445517
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: