Healthcare Provider Details

I. General information

NPI: 1508382748
Provider Name (Legal Business Name): NATANYA L JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 LAFAYETTE AVE
SUFFERN NY
10901-4812
US

IV. Provider business mailing address

255 LAFAYETTE AVE
SUFFERN NY
10901-4812
US

V. Phone/Fax

Practice location:
  • Phone: 845-326-7859
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360099
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number734474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: