Provider Demographics
NPI:1689900417
Name:FANGMEYER, JOHANNA (MSN, CRNP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:FANGMEYER
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13424 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-2658
Mailing Address - Country:US
Mailing Address - Phone:301-370-6688
Mailing Address - Fax:
Practice Address - Street 1:13424 PENNSYLVANIA AVE
Practice Address - Street 2:STE 101
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2658
Practice Address - Country:US
Practice Address - Phone:301-370-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR134352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner