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General NPI Number Information
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NPI Number | 1356607931
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Entity Type | Individual
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Provider Name | JOHANNA CLARA NESSE FNP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 1620 E 12TH ST
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City | THE DALLES
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State | OR
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Zip | 97058-3213
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Country | US
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Telephone | 541-296-9151
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Fax | 541-296-9156
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Provider Business Mailing Address
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Address Line | PO BOX 1520
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City | THE DALLES
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State | OR
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Zip | 97058-1520
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Country | US
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Telephone | 541-296-7668
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Fax | 541-296-6431
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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 | 990369
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License Number State | CO
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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 | 20120079NP
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License Number State | OR
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