Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 187677-PC | MA |
NPI | 1033137237 |
---|---|
Provider Name | Jocelyn O Johnson |
First Address | Amherst, MA 01002-1717 |
Second Address | Amherst, MA 01002-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1858734 | (05) | MA |
NS-0356 | (02) |