Healthcare Provider Details

I. General information

NPI: 1396005997
Provider Name (Legal Business Name): MABINTU JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE 228
WASHINGTON DC
20002-1848
US

IV. Provider business mailing address

1818 NEW YORK AVE NE 228
WASHINGTON DC
20002-1848
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax:
Mailing address:
  • Phone: 202-832-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN1002723
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: