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General NPI Number Information
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NPI Number | 1396682704
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Entity Type | Individual
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Provider Name | PATRICK JOHANNESSEN
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Gender | Male
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 1605 VICTORIAN AVE
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City | SPARKS
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State | NV
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Zip | 89431-4822
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Country | US
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Telephone | 775-353-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 4170 PILLARY CT
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City | SPARKS
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State | NV
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Zip | 89436-7615
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Country | US
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Telephone | 707-315-5387
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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 | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 78479
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License Number State | NV
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