Healthcare Provider Details

I. General information

NPI: 1982247540
Provider Name (Legal Business Name): JOHNA ANN RADFORD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ARCADE AVE STE 320
ELKHART IN
46514-2485
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-523-7900
  • Fax: 574-523-7909
Mailing address:
  • Phone: 574-647-3725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28147796A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: