Johanson, Jacqueline S

Johanson, Jacqueline S is an individual health care provider with primary practice located at 310 Lafayette Ave Se Ste 410 , Grand Rapids MI 49503-4693. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Johanson, Jacqueline S can be contacted via phone (616) 685-8200.

Contact Information

Primary practice address
310 Lafayette Ave Se Ste 410 Grand Rapids MI 49503-4693
Phone: (616) 685-8200
Fax: (616) 685-8202
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 5601008301 Michigan

Profile Details

NPI number 1952304982
LBN Legal business name Johanson, Jacqueline S
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date May 23rd, 2005
Last updated Dec 28th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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