Healthcare Provider Details

I. General information

NPI: 1679900864
Provider Name (Legal Business Name): SAMMI JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 HARRISON AVENUE MORGAN COUNTY BOARD OF EDUCATION
BERKELEY SPRINGS WV
25411
US

IV. Provider business mailing address

247 HARRISON AVENUE MORGAN COUNTY BOARD OF EDUCATION
BERKELEY SPRINGS WV
25411
US

V. Phone/Fax

Practice location:
  • Phone: 304-267-3595
  • Fax: 307-267-3599
Mailing address:
  • Phone: 304-267-3595
  • Fax: 307-267-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number73215
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: