Healthcare Provider Details

I. General information

NPI: 1386728129
Provider Name (Legal Business Name): CHRISTINE MARY JOHNSEN NP, CNS, APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 EASTBROOK RD
DEDHAM MA
02026-2075
US

IV. Provider business mailing address

87 6TH ST
CAMBRIDGE MA
02141-2014
US

V. Phone/Fax

Practice location:
  • Phone: 781-329-9365
  • Fax:
Mailing address:
  • Phone: 617-492-2896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number199217
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number199217
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: