MEDICARE: CYNTHIA YVONNE JOHNSON REGISTERED NURSE

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
1	347C00000X	Private Vehicle	LC001687743	MO

General Provider Information

NPI Number	:	1518767268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA YVONNE JOHNSON REGISTERED NURSE

Provider Business Mailing Address
First Line	:	2170 ROUNTREE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-6135
Country	:	US
Telephone Number	:	314-956-4482
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 S BEMISTON AVE STE 800
Second Line	:
City	:	CLAYTON
State	:	MO
Zip	:	63105-1925
Country	:	US
Telephone Number	:	314-303-5734
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2025
Last Update Date	:	03/20/2025

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