Healthcare Provider Details

I. General information

NPI: 1053611715
Provider Name (Legal Business Name): CATHERINE MARIE JOHNSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BONIFACE DR
PINE BUSH NY
12566-7011
US

IV. Provider business mailing address

111 MALTESE DR
MIDDLETOWN NY
10940-2115
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-4499
  • Fax:
Mailing address:
  • Phone: 845-342-4774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF336435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: