| Doctor Name: | JOHANNA ELLEN FICKETT |
| NPI Number: | 1114014644 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N. |
| License Number: | 027695 |
| Business Practice Address: | 1270 Kot-num Rd Warm Springs, OR - 97761 |
| Business Phone Number: | 5415531196 |
| Business Fax Number: | 5415532457 |
| Mailing Address: | Po Box 215, MADRAS |
| State: | OR |
| Postal Code: | 977410036 |
| Phone Number: | 5415531196 |
| Fax Number: | 5415532457 |
| NPI Enumeration Date: | 10/06/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC1500X |
| License Number: | 027695 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |