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General NPI Number Information
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NPI Number | 1497260525
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Entity Type | Individual
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Provider Name | JEANNIE ELLEN JOHNSON CNP
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 4242 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44113-3715
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Country | US
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Telephone | 216-420-8383
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Fax | 216-664-6159
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Provider Business Mailing Address
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Address Line | 14701 ONAWAY RD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-2846
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Country | US
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Telephone | 216-965-2225
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN.CNP.020550
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License Number State | OH
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