Provider Demographics
NPI:1194029397
Name:JOHNSON, RACHAEL LOTTIE (CRNP-F)
Entity Type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:LOTTIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP-F
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:LOTTIE
Other - Last Name:FREDERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1002
Mailing Address - Country:US
Mailing Address - Phone:301-665-9696
Mailing Address - Fax:240-420-5715
Practice Address - Street 1:1150 PROFESSIONAL CT
Practice Address - Street 2:SUITE P
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4100
Practice Address - Country:US
Practice Address - Phone:301-665-9696
Practice Address - Fax:240-420-5715
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR224985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily