Healthcare Provider Details

I. General information

NPI: 1548274087
Provider Name (Legal Business Name): TRACEY L. JOHNSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR SUITE 126Q
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

LAHEY HOSPITAL AND MEDICAL CENTER 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-524-8181
  • Fax:
Mailing address:
  • Phone: 781-744-8580
  • Fax: 781-744-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP 204973
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: