Provider Demographics
NPI:1831796721
Name:ALLEN ARNTZEN, JOHANNA TYSON (CNM)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:TYSON
Last Name:ALLEN ARNTZEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:TYSON
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:2106 23RD AVE APT 3D
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3456
Mailing Address - Country:US
Mailing Address - Phone:253-906-0221
Mailing Address - Fax:
Practice Address - Street 1:4781 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-4915
Practice Address - Country:US
Practice Address - Phone:212-304-6920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty