Provider Demographics
NPI:1689097461
Name:JOHNNS, ELOISE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:ELOISE
Middle Name:
Last Name:JOHNNS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14
Mailing Address - Street 2:
Mailing Address - City:LACLEDE
Mailing Address - State:ID
Mailing Address - Zip Code:83841-0014
Mailing Address - Country:US
Mailing Address - Phone:509-344-9727
Mailing Address - Fax:
Practice Address - Street 1:2651 S C ST
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033-3560
Practice Address - Country:US
Practice Address - Phone:805-983-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60445517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily