Provider Demographics
NPI:1932490083
Name:JOHNSON, COLLEEN ANN (CNS)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 WHITE POND DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1155
Mailing Address - Country:US
Mailing Address - Phone:330-572-1011
Mailing Address - Fax:330-572-1018
Practice Address - Street 1:701 WHITE POND DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1155
Practice Address - Country:US
Practice Address - Phone:330-572-1011
Practice Address - Fax:330-572-1018
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2010012935364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3160369Medicaid
OH3160369Medicaid