Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F332519 | NY |
NPI | 1013118223 |
---|---|
Provider Name | Miss Carol M Johnson |
First Address | Jamaica, NY 11434-4546 |
Second Address | New York, NY 10016-9196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2007 |
Last Update Date | 08/07/2007 |