Provider Demographics
NPI:1871012468
Name:JOHANSMEYER, FIONA DEBRA (PA)
Entity Type:Individual
Prefix:
First Name:FIONA
Middle Name:DEBRA
Last Name:JOHANSMEYER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 PROVIDENCE HWY
Mailing Address - Street 2:
Mailing Address - City:EAST WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02032-1512
Mailing Address - Country:US
Mailing Address - Phone:781-255-0500
Mailing Address - Fax:
Practice Address - Street 1:103 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:EAST WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02032-1512
Practice Address - Country:US
Practice Address - Phone:781-255-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6181363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPA6181OtherLICENSE NUMBER