Healthcare Provider Details

I. General information

NPI: 1821186735
Provider Name (Legal Business Name): PENNY FLEETWOOD JOHNSON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST SUITE 605
SALISBURY MD
21804-6953
US

IV. Provider business mailing address

36658 ROBIN HOOD RD
DELMAR DE
19940-2326
US

V. Phone/Fax

Practice location:
  • Phone: 410-334-2227
  • Fax: 410-341-3225
Mailing address:
  • Phone: 410-334-2227
  • Fax: 410-341-3225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR123383
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000336
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171560
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013903
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: