Provider Demographics
NPI:1144709403
Name:CANSLER, JOHNNI JO (APRN)
Entity type:Individual
Prefix:
First Name:JOHNNI
Middle Name:JO
Last Name:CANSLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 SW HUBER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6140
Mailing Address - Country:US
Mailing Address - Phone:931-494-0456
Mailing Address - Fax:
Practice Address - Street 1:4225 SW HUBER ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6140
Practice Address - Country:US
Practice Address - Phone:931-494-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014202363LP0808X
OR10002824363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health