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NPI Code Detail

MEDICARE: ELIZABETH JOHLE CRNP

MEDICARE:   ELIZABETH  JOHLE  CRNP
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
1363LF0000XFamily Nurse PractitionerR166630MD

General Provider Information

NPI Number : 1164756433
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH JOHLE CRNP
Provider Business Mailing Address
First Line : 2601 RIVA RD
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-7304
Country : US
Telephone Number : 612-225-1538
Fax Number :
Provider Business Practice Location Address
First Line : 2601 RIVA RD
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-7304
Country : US
Telephone Number : 612-225-1538
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2009
Last Update Date : 05/12/2011

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