Healthcare Provider Details

I. General information

NPI: 1457566135
Provider Name (Legal Business Name): CINDY JO JOHNSON APRN/BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 CENTERVILLE ROAD SUITE 105
WARWICK RI
02886-4448
US

IV. Provider business mailing address

469 CENTERVILLE ROAD SUITE 105
WARWICK RI
02886-4448
US

V. Phone/Fax

Practice location:
  • Phone: 401-773-3700
  • Fax: 401-773-3701
Mailing address:
  • Phone: 401-773-3700
  • Fax: 401-773-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00095300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN01953
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: