MEDICARE: JILL D. JOHNSON M.S.N., A.P.R.N.

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	363L00000X	Nurse Practitioner	RN139779	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	341966854	OTHER	UNITED HEALTH CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	341966854	OTHER	FAMILY HEALTH PLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	341966854	OTHER	CIGNA
6	341966854	OTHER	NATIONWIDE
7	341966854	OTHER	AETNA
8	000000306931	OTHER	ANTHEM
9	341966854	OTHER	BUCKEYE COMMUNITY HEALTH PLAN
10	341966854	OTHER	HUMANA
11	341966854	OTHER	PARAMOUNT
12	341966854	OTHER	OHIO WORKERS COMPENSATION

General Provider Information

NPI Number	:	1962405092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL D. JOHNSON M.S.N., A.P.R.N.

Provider Business Mailing Address
First Line	:	5800 MONROE ST
Second Line	:	BLDG G
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2263
Country	:	US
Telephone Number	:	419-885-2525
Fax Number	:	419-885-3253

Provider Business Practice Location Address
First Line	:	5800 MONROE ST
Second Line	:	BLDG G
City	:	SYLVANIA
State	:	OH
Zip	:	43560-2263
Country	:	US
Telephone Number	:	419-885-2525
Fax Number	:	419-885-3253

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/16/2008

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