Healthcare Provider Details

I. General information

NPI: 1679732697
Provider Name (Legal Business Name): PATRICIA A JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 08/12/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

IV. Provider business mailing address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-1100
  • Fax: 585-596-4005
Mailing address:
  • Phone: 585-593-1100
  • Fax: 585-596-4005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: