Provider Demographics
NPI:1770713380
Name:JOHNSON, JOANN (PA-C)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 KEYSTONE INDUSTRIAL PARK
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-1530
Mailing Address - Country:US
Mailing Address - Phone:570-341-7777
Mailing Address - Fax:570-341-7789
Practice Address - Street 1:769 KEYSTONE INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-1530
Practice Address - Country:US
Practice Address - Phone:570-341-7777
Practice Address - Fax:570-341-7789
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051764363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00000OtherNONE