Healthcare Provider Details

I. General information

NPI: 1306425087
Provider Name (Legal Business Name): JOSHUA MATHEW JOHNSON FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 01/17/2023
Certification Date: 01/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANSING ST
AUBURN NY
13021-1983
US

IV. Provider business mailing address

17 LANSING ST
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0437
  • Fax: 315-253-1702
Mailing address:
  • Phone: 315-567-0437
  • Fax: 315-253-1702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number347970
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: