Healthcare Provider Details

I. General information

NPI: 1497451231
Provider Name (Legal Business Name): SAMELIA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 WALNUT ST
PHILADELPHIA PA
19139-3836
US

IV. Provider business mailing address

6509 ALGARD ST
PHILADELPHIA PA
19135-2613
US

V. Phone/Fax

Practice location:
  • Phone: 215-474-4444
  • Fax:
Mailing address:
  • Phone: 267-707-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06220452
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: