Healthcare Provider Details

I. General information

NPI: 1053747626
Provider Name (Legal Business Name): EMILY DENISE JOHNSON CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 N. EUTAW ST
BALTIMORE MD
21201
US

IV. Provider business mailing address

3651 CHESTNUT AVE
BALTIMORE MD
21211
US

V. Phone/Fax

Practice location:
  • Phone: 410-523-2150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR171881
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR171881
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: