Healthcare Provider Details

I. General information

NPI: 1215520416
Provider Name (Legal Business Name): DAVID VERNON JOHNSON RN/EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7753 ROCKANNA RD
PASADENA MD
21122-2336
US

IV. Provider business mailing address

7753 ROCKANNA RD
PASADENA MD
21122-2336
US

V. Phone/Fax

Practice location:
  • Phone: 144-379-0870
  • Fax:
Mailing address:
  • Phone: 443-790-8703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR187894
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberCS00180
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: