Healthcare Provider Details

I. General information

NPI: 1548771751
Provider Name (Legal Business Name): JOHNATHAN RICHARD DODSON CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2017
Last Update Date: 12/05/2025
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

IV. Provider business mailing address

111 S FRONT ST
HARRISBURG PA
17101-2010
US

V. Phone/Fax

Practice location:
  • Phone: 717-231-8772
  • Fax: 717-231-8435
Mailing address:
  • Phone: 717-231-8772
  • Fax: 717-231-8435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN606961
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberSP018285
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: