MEDICARE: GWENDOLYN 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	N10080	NY

General Provider Information

NPI Number	:	1861347296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN JOHNSON

Provider Business Mailing Address
First Line	:	84 GRETNA WOODS RD
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-6965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 GRETNA WOODS RD
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-6965
Country	:	US
Telephone Number	:	845-952-0950
Fax Number	:

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

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “ GWENDOLYN JOHNSON ” Practice Location

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