Provider Demographics
NPI:1336395706
Name:JOHNSON, ERICA L (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4853
Mailing Address - Country:US
Mailing Address - Phone:419-309-2659
Mailing Address - Fax:
Practice Address - Street 1:1125 W WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-4853
Practice Address - Country:US
Practice Address - Phone:419-206-7258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-17
Last Update Date:2021-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61151126163W00000X
WI256698-30163W00000X
OHRN270058163W00000X
OHAPRN-CNP026168363LP0808X
WI10456-33363LP0808X
OHAPRN.CNP026168363LP0808X
WA61151704363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0403888Medicaid