Basic Information
| Provider Information | |||||||||
| NPI: | 1457417875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSEN MARTIN | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | HOPE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N. DUKE ST. | ||||||||
| Address2: | PO BOX 3555 | ||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176043555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444940 | ||||||||
| FaxNumber: | 7175442690 | ||||||||
| Practice Location | |||||||||
| Address1: | 540 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175444950 | ||||||||
| FaxNumber: | 7175445964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 11/04/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS014047 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.