=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457417875
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIRSTEN HOPE JOHNSEN MARTIN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2006
-----------------------------------------------------
Last Update Date | 11/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 540 N DUKE ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17602-2374
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-544-4950
-----------------------------------------------------
Fax | 717-544-5964
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 N. DUKE ST. PO BOX 3555
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17604-3555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-544-4940
-----------------------------------------------------
Fax | 717-544-2690
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS014047
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------