Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | R172158 | MD |
NPI | 1023252129 |
---|---|
Provider Name | Pamela Penina Johnson |
First Address | Baltimore, MD 21217 |
Second Address | Baltimore, MD 21217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 21/04/2009 |