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General NPI Number Information
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NPI Number | 1265049324
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Entity Type | Individual
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Provider Name | JOHANNA CATHERINE MCKENNA CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 18 OLD ETNA RD
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City | LEBANON
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State | NH
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Zip | 03766-1937
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Country | US
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Telephone | 603-650-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 2802 URBANA DR
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City | SILVER SPRING
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State | MD
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Zip | 20906-5033
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Country | US
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Telephone | 603-630-4454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R220471
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 111369-23
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License Number State | NH
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