MEDICARE: FIONA DEBRA JOHANSMEYER PA

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	363AM0700X	Medical Physician Assistant	PA6181	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA6181	OTHER	MA	LICENSE NUMBER

General Provider Information

NPI Number	:	1871012468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIONA DEBRA JOHANSMEYER PA

Provider Business Mailing Address
First Line	:	103 PROVIDENCE HWY
Second Line	:
City	:	EAST WALPOLE
State	:	MA
Zip	:	02032-1512
Country	:	US
Telephone Number	:	781-255-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PROVIDENCE HWY
Second Line	:
City	:	EAST WALPOLE
State	:	MA
Zip	:	02032-1512
Country	:	US
Telephone Number	:	781-255-0500
Fax Number	:

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

Provider Enumeration Date	:	09/14/2017
Last Update Date	:	07/12/2022

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