Provider Demographics
NPI:1548201940
Name:COMMONS, JOANNA LEE (RNBC, NP-C)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:LEE
Last Name:COMMONS
Suffix:
Gender:F
Credentials:RNBC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:WEST LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:47991-8089
Mailing Address - Country:US
Mailing Address - Phone:765-893-4299
Mailing Address - Fax:
Practice Address - Street 1:5026 W US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-9770
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:612-659-7101
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28079503A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232230CCMedicare UPIN