Provider Demographics
NPI:1457648198
Name:JOHANNES, JENNIFER M (DO)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 NIAGARA RD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401
Mailing Address - Country:US
Mailing Address - Phone:970-497-7925
Mailing Address - Fax:855-855-4482
Practice Address - Street 1:1550 NIAGARA RD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-497-7925
Practice Address - Fax:855-855-4482
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60649442208600000X
COCDRH.0059996208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery