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Individual

ELISE JOHANNESEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
711 SL YOUNG BLVD, OKLAHOMA CITY, OK 73104-5023
(405) 271-4113
Mailing address
711 SL YOUNG BLVD, OKLAHOMA CITY, OK 73104-5023
(405) 271-4113

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
30075
OK
207R00000X
Internal Medicine Physician
Primary
R4568
TX
208000000X
Pediatrics Physician
30075
OK

Other

Enumeration date
05/14/2013
Last updated
03/31/2026
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