Healthcare Provider Details

I. General information

NPI: 1003127549
Provider Name (Legal Business Name): ANNETTE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 NEW YORK AVE
BROOKLYN NY
11225-5217
US

IV. Provider business mailing address

582 NEW YORK AVE
BROOKLYN NY
11225-5217
US

V. Phone/Fax

Practice location:
  • Phone: 718-735-7006
  • Fax:
Mailing address:
  • Phone: 718-735-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number5267421
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: