| Doctor Name: | JENNIFER NICOLE JOHNSON |
| NPI Number: | 1437174877 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 3088 |
| Business Practice Address: | Raf Lakenheath 48 Mdg/sghc Unit 5115 Apo, AE - 094615115 |
| Business Phone Number: | 011441638528124 |
| Business Fax Number: | |
| Mailing Address: | Raf Lakenheath 48 Mdg/sghc, Unit 5115 APO |
| State: | AE |
| Postal Code: | 094615115 |
| Phone Number: | 011441638528124 |
| Fax Number: | |
| NPI Enumeration Date: | 07/13/2006 |
| NPI Last Update Date: | 09/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 3088 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NM |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |