Provider Demographics
NPI:1669404810
Name:JOHNSON, JENNIFER H (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
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 1:3400 E RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-2344
Mailing Address - Country:US
Mailing Address - Phone:608-373-8000
Mailing Address - Fax:608-373-8514
Practice Address - Street 1:3400 E RACINE ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-2344
Practice Address - Country:US
Practice Address - Phone:608-373-8000
Practice Address - Fax:608-373-8514
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32667-20208M00000X
WI32667207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31774800Medicaid
WI1669404810Medicaid
WI31774800Medicaid
WI31774800Medicaid