Healthcare Provider Details

I. General information

NPI: 1801221114
Provider Name (Legal Business Name): ELIZABETH JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5760 PATRIOT BLVD STE C
AUSTINTOWN OH
44515-1170
US

IV. Provider business mailing address

65 MESSIMER DR
NEWARK OH
43055-1874
US

V. Phone/Fax

Practice location:
  • Phone: 330-270-8610
  • Fax: 330-270-2690
Mailing address:
  • Phone: 740-522-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.022154
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 312490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: