Provider Demographics
NPI:1891104626
Name:JOHNSON, KATHLEEN SUSAN (MSN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:SUSAN
Last Name:JOHNSON
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Gender:F
Credentials:MSN, NP-C
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Mailing Address - Street 1:2109 HUGHES DR
Mailing Address - Street 2:SUITE 760
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3856
Mailing Address - Country:US
Mailing Address - Phone:419-291-7555
Mailing Address - Fax:419-479-2696
Practice Address - Street 1:2109 HUGHES DR
Practice Address - Street 2:SUITE 760
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3856
Practice Address - Country:US
Practice Address - Phone:419-291-7555
Practice Address - Fax:419-479-2696
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2023-11-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.16241-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH398970Medicare PIN