Individual provider Active NPI

Janet S Johanson, NP RN

  • Women's Health Nurse Practitioner
  • San Rafael, CA
National Provider Identifier
1811095813
Registry record updated Dec 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
2008 Issued in CA
Practice address
3260 Kerner Blvd
San Rafael, CA 94901-4861
Phone
(415) 473-6852
Fax
(415) 473-4018
NPI assigned
Sep 21, 2006
Last updated
Dec 17, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 2008 CA Primary
Ambulatory Women's Health Care Registered Nurse 163WW0101X 199279 CA

Addresses

Primary practice location

3260 Kerner Blvd
San Rafael, CA 94901-4861

Mailing address

131 Highland Ave
San Rafael, CA 94901-2247
Phone (415) 456-0620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
199279CAMDAmbulatory Women's Health Care Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229472000000",
    "number": "1811095813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 HIGHLAND AVE",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949012247",
            "telephone_number": "415-456-0620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 KERNER BLVD",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949014861",
            "telephone_number": "415-473-6852",
            "fax_number": "415-473-4018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHANSON",
        "first_name": "JANET",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "NP RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-21",
        "last_updated": "2008-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CA",
            "license": "2008",
            "primary": true
        },
        {
            "code": "163WW0101X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Women's Health Care, Ambulatory",
            "state": "CA",
            "license": "199279",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Rafael, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.