MEDICARE: MS. ELIZABETH JOHNSON FNP

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	163W00000X	Registered Nurse	RN 312490	OH
2	363LF0000X	Family Nurse Practitioner	CNP.022154	OH

General Provider Information

NPI Number	:	1801221114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH JOHNSON FNP

Provider Business Mailing Address
First Line	:	65 MESSIMER DR
Second Line	:
City	:	NEWARK
State	:	OH
Zip	:	43055-1874
Country	:	US
Telephone Number	:	740-522-8477
Fax Number	:

Provider Business Practice Location Address
First Line	:	5760 PATRIOT BLVD STE C
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1170
Country	:	US
Telephone Number	:	330-270-8610
Fax Number	:	330-270-2690

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

Provider Enumeration Date	:	09/05/2013
Last Update Date	:	09/23/2019

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