MEDICARE: ERNESTINE KITTI JOHNSON

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	163W00000X	Registered Nurse	RN357130	OH

General Provider Information

NPI Number	:	1760867303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERNESTINE KITTI JOHNSON

Provider Business Mailing Address
First Line	:	3325 CAMVIC TER APT 2
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3630
Country	:	US
Telephone Number	:	513-543-4246
Fax Number	:

Provider Business Practice Location Address
First Line	:	3325 CAMVIC TER APT 2
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-3630
Country	:	US
Telephone Number	:	513-543-4246
Fax Number	:

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

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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