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General NPI Number Information
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NPI Number | 1659518991
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Entity Type | Individual
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Provider Name | AMELIA FAYE JOHNSON GRUND PMH, NP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/31/2022
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Provider Practice Location Address
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Address Line | 336 GLESSNER AVE MOB 2ND FL
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City | MANSFIELD
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State | OH
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Zip | 44903
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Country | US
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Telephone | 419-520-2826
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Fax | 419-526-8284
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Provider Business Mailing Address
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Address Line | 5450 FRANTZ RD STE 360
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City | DUBLIN
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State | OH
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Zip | 43016-4141
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Country | US
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Telephone | 614-544-6155
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Fax | 614-544-6370
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.10350
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License Number State | OH
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