Provider Demographics
NPI:1447256532
Name:JOHNSON, DANYELL (ANP)
Entity type:Individual
Prefix:MRS
First Name:DANYELL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:419-479-5327
Mailing Address - Fax:419-479-5593
Practice Address - Street 1:1000 REGENCY COURT
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3074
Practice Address - Country:US
Practice Address - Phone:419-479-2665
Practice Address - Fax:419-479-2639
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP08330363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2643474Medicaid
Q55206Medicare UPIN
OHNP36291Medicare PIN
OH$$$$$$$$$00OtherWORKERS COMPENSATION