Provider Demographics
NPI:1477690634
Name:JOHNSON, RONNA MICHELLE (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:RONNA
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2422
Mailing Address - Country:US
Mailing Address - Phone:330-434-4141
Mailing Address - Fax:
Practice Address - Street 1:7968 COOLEY RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9753
Practice Address - Country:US
Practice Address - Phone:330-296-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-167932163WP0200X
OHAPRN.CNP.06233363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No163WP0200XNursing Service ProvidersRegistered NursePediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2126667Medicaid
OHNP-06233OtherCERT NURSE PRACTITIONER