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NPI Code Detail

MEDICARE: MS. SUSAN MAYBERRY JOHNSON RN

MEDICARE: MS. SUSAN MAYBERRY JOHNSON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WA2000XAdministrator Registered Nurse086530NC

General Provider Information

NPI Number : 1477654192
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUSAN MAYBERRY JOHNSON RN
Provider Business Mailing Address
First Line : 112 KNOLLCREST LN
Second Line :
City : STATESVILLE
State : NC
Zip : 28625-2285
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 318 TURNERSBURG HWY
Second Line :
City : STATESVILLE
State : NC
Zip : 28625-2798
Country : US
Telephone Number : 704-878-5300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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