Provider Demographics
NPI:1639137821
Name:JOHNSON, JODI L (CRNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 WILSON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3697
Mailing Address - Country:US
Mailing Address - Phone:717-243-7540
Mailing Address - Fax:717-243-9968
Practice Address - Street 1:220 WILSON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3697
Practice Address - Country:US
Practice Address - Phone:717-243-7540
Practice Address - Fax:717-243-9968
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007500363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50001116OtherCAPITAL BLUE CROSS IND
PAP98857Medicare UPIN
PA073584 R4BMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL