Provider Demographics
NPI:1811095813
Name:JOHANSON, JANET S (NP RN)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:S
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:NP RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2247
Mailing Address - Country:US
Mailing Address - Phone:415-456-0620
Mailing Address - Fax:
Practice Address - Street 1:3260 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4861
Practice Address - Country:US
Practice Address - Phone:415-473-6852
Practice Address - Fax:415-473-4018
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA199279163WW0101X
CA2008363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory