1952425662 NPI number — MRS. JAN J JOHNSON PT

Table of content: MRS. JAN J JOHNSON PT (NPI 1952425662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952425662 NPI number — MRS. JAN J JOHNSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JAN
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HULSE
Provider Other First Name:
JAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952425662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 THOMAS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOWE
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05672-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-253-8869
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1878 MOUNTAIN RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STOWE
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05672-4775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-253-2273
Provider Business Practice Location Address Fax Number:
802-253-7754
Provider Enumeration Date:
03/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  040-0002878 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)