Healthcare Provider Details

I. General information

NPI: 1669136768
Provider Name (Legal Business Name): EMILY ANNE JOHNSON MSN, AGACNP-BC, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

20 LORIS RD
PEABODY MA
01960-1611
US

V. Phone/Fax

Practice location:
  • Phone: 857-231-2686
  • Fax:
Mailing address:
  • Phone: 857-231-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2270464
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: