Healthcare Provider Details

I. General information

NPI: 1285733899
Provider Name (Legal Business Name): JANE MARGARET JOHANNSEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 EAST RIVER STREET EMH REGIONAL MEDICAL CENTER
ELYRIA OH
44035
US

IV. Provider business mailing address

13810 BUTLER ROAD
WAKEMAN OH
44889-9026
US

V. Phone/Fax

Practice location:
  • Phone: 440-326-5471
  • Fax: 440-329-7711
Mailing address:
  • Phone: 440-965-5601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP00166
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN096227
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: