Healthcare Provider Details

I. General information

NPI: 1588611446
Provider Name (Legal Business Name): JOHANNE LOUIS DNP, CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/18/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5880
  • Fax: 215-823-4309
Mailing address:
  • Phone: 215-301-7171
  • Fax: 215-823-4309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP005579B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: