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General NPI Number Information
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NPI Number | 1093277709
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Entity Type | Organization
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Legal Business Name | DEBRA V JOHNSON, APRN
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Dates
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Enumeration Date | 04/02/2019
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 35 TOWER LN UNIT 102
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City | AVON
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State | CT
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Zip | 06001-4237
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Country | US
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Telephone | 860-983-0655
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Fax |
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Provider Business Mailing Address
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Address Line | 22 TRAINOR DR
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City | WEATOGUE
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State | CT
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Zip | 06089-9613
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Country | US
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Telephone | 860-983-0655
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Fax |
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Authorized Official
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Title or Position | BILLING ADMINISTRATOR
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Name | SUE ROACH
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Credential |
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Telephone | 860-368-7092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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