Healthcare Provider Details

I. General information

NPI: 1184957516
Provider Name (Legal Business Name): MS. DEBORAH K JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOSPITAL DR
TARBORO NC
27886-2011
US

IV. Provider business mailing address

360 CORBETT RD
GOLDSBORO NC
27534-7910
US

V. Phone/Fax

Practice location:
  • Phone: 252-641-7229
  • Fax: 252-641-7388
Mailing address:
  • Phone: 919-778-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number65826
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number083018
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: