=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811245202
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DORENE (DODIE) L JOHNSON CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2012
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 FORRER BLVD STE 250
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45420-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 9-864-8018
-----------------------------------------------------
Fax | 937-684-9990
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 FORRER BLVD STE 250
-----------------------------------------------------
City | KETTERING
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45420-3640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-986-4801
-----------------------------------------------------
Fax | 937-684-9990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP.CNP.13325
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------