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General NPI Number Information
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NPI Number | 1457648198
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Entity Type | Individual
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Provider Name | JENNIFER M JOHANNES D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 630 E STAR CT
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City | MONTROSE
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State | CO
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Zip | 81401-6702
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Country | US
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Telephone | 970-497-7925
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Fax | 855-855-4482
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Provider Business Mailing Address
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Address Line | 1550 NIAGARA RD
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City | MONTROSE
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State | CO
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Zip | 81401
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Country | US
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Telephone | 970-497-7925
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Fax | 855-855-4482
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | OP60649442
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | CDRH.0059996
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License Number State | CO
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