Healthcare Provider Details

I. General information

NPI: 1437607124
Provider Name (Legal Business Name): STEFANIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6696 US HIGHWAY 20A
DELTA OH
43515-9799
US

IV. Provider business mailing address

6696 US HIGHWAY 20A
DELTA OH
43515-9799
US

V. Phone/Fax

Practice location:
  • Phone: 419-822-3242
  • Fax: 419-822-9008
Mailing address:
  • Phone: 419-822-3242
  • Fax: 419-822-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.019687
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: