MEDICARE: DEBRA A JOHNSEN CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	NP-03967	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00194628	OTHER	OH	RAIL ROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104874254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA A JOHNSEN CNP

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-5501
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	3120 BURNET AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3091
Country	:	US
Telephone Number	:	513-584-8600
Fax Number	:	513-584-8620

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/19/2018

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Directions to “ DEBRA A JOHNSEN CNP” Practice Location

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