Healthcare Provider Details

I. General information

NPI: 1811095813
Provider Name (Legal Business Name): JANET S JOHANSON NP RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 KERNER BLVD
SAN RAFAEL CA
94901-4861
US

IV. Provider business mailing address

131 HIGHLAND AVE
SAN RAFAEL CA
94901-2247
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6852
  • Fax: 415-473-4018
Mailing address:
  • Phone: 415-456-0620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number199279
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2008
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: