Provider Demographics
NPI:1811245202
Name:JOHNSON, DORENE L (CNP)
Entity type:Individual
Prefix:
First Name:DORENE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 FORRER BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45420-3640
Mailing Address - Country:US
Mailing Address - Phone:800-986-4801
Mailing Address - Fax:937-684-9990
Practice Address - Street 1:1050 FORRER BLVD STE 250
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45420-3640
Practice Address - Country:US
Practice Address - Phone:009-864-8018
Practice Address - Fax:937-684-9990
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHARNP.CNP.13325363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH134990Medicare PIN