=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124233473
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESA M JOHNSON RN BC APRN LADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 361 PARK RD 3RD FL
-----------------------------------------------------
City | WEST HURTFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-523-1101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9A FARMINGTON CHASE CRESCENT
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06032-3132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-677-0367
-----------------------------------------------------
Fax | 860-677-0367
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | LADC000161
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RNE33028
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | APRN002487
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------