Provider Demographics
NPI:1801104773
Name:JOHNSON, DIANNE CAROLINE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:DIANNE
Middle Name:CAROLINE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 S MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1035
Mailing Address - Country:US
Mailing Address - Phone:234-200-2770
Mailing Address - Fax:
Practice Address - Street 1:388 S MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1035
Practice Address - Country:US
Practice Address - Phone:234-200-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11536-NP363LF0000X
OHAPRN.CNP.11536363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3085049Medicaid
OH3085049Medicaid