Individual
NOELLE MARIE JOHANSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5220
Mailing address
PO BOX 825366, PHILADELPHIA, PA 19182-5366
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
OS017385
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
OS017385
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0393924
—
NJ
01
—
336215DBF
MEDICARE
—
Enumeration date
06/24/2008
Last updated
05/22/2024
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