Healthcare Provider Details

I. General information

NPI: 1639520273
Provider Name (Legal Business Name): ALICE VICTORIA JOHNSON CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 4TH ST
SAN FRANCISCO CA
94143-2351
US

IV. Provider business mailing address

355 E 88TH ST APT 2D
NEW YORK NY
10128-4924
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3831
  • Fax:
Mailing address:
  • Phone: 248-470-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number382724
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number700935
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95187800
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95011678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: