Provider Demographics
NPI:1265777965
Name:JOHNSON, NANCY K (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W MATHER LN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-1158
Mailing Address - Country:US
Mailing Address - Phone:216-249-9444
Mailing Address - Fax:216-851-3919
Practice Address - Street 1:16 W MATHER LN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1158
Practice Address - Country:US
Practice Address - Phone:216-249-9444
Practice Address - Fax:216-851-3919
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35019742207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology