Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 041673 | CT |
Y | 207RH0003X | Hematology & Oncology | 041673 | CT |
NPI | 1326047549 |
---|---|
Provider Name | Dr. Vanessa M.p. Johnson |
First Address | Norwich, CT 06360-2700 |
Second Address | Norwich, CT 06360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 24/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001416735 | (05) | CT |
H17576 | (02) |