Provider Demographics
NPI:1932198371
Name:JOHNS, LORI ANN (RN,MN, FNP- BC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ANN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:RN,MN, FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 NE 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY BEACH
Mailing Address - State:OR
Mailing Address - Zip Code:97136-9312
Mailing Address - Country:US
Mailing Address - Phone:916-202-5799
Mailing Address - Fax:
Practice Address - Street 1:1021 NE 13TH AVE
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:OR
Practice Address - Zip Code:97136-9312
Practice Address - Country:US
Practice Address - Phone:916-202-5799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6699363LF0000X
OR201050034NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201050034NPOtherNP LICENSE
CA359033OtherRN
OR201040443RNOtherRN LICENSE
CA6699OtherNURSE PRACTITIONER FURNISHING NUMBER & CERTIFICATE