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General NPI Number Information
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NPI Number | 1275093460
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Entity Type | Individual
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Provider Name | MABEL YATTA JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2019
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 81 BRIDGE ST # 215
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City | LOWELL
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State | MA
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Zip | 01852-1270
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Country | US
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Telephone | 978-459-2306
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Fax | 978-453-9394
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Provider Business Mailing Address
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Address Line | 24 OAK AVE
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City | TYNGSBORO
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State | MA
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Zip | 01879-1779
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Country | US
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Telephone | 978-995-2533
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Fax | 888-340-6599
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number | 265003
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License Number State | MA
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