Healthcare Provider Details

I. General information

NPI: 1861720138
Provider Name (Legal Business Name): TASHI JOHNSON-CAMPBELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 MADISON AVE
NEW YORK NY
10029
US

IV. Provider business mailing address

470 LENOX AVE APT 9P NEW YORK
NEW YORK NY
10037-3026
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-6500
  • Fax:
Mailing address:
  • Phone: 347-688-1862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number536852
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number012330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: