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General NPI Number Information
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NPI Number | 1558081448
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Entity Type | Individual
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Provider Name | JOHNCY SUSAN JOHN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2022
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Last Update Date | 08/31/2022
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Provider Practice Location Address
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Address Line | ROCKLAND URGENT CARE 89 S RTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993
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Country | US
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Telephone | 845-747-0468
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Fax |
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Provider Business Mailing Address
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Address Line | 4 BARRY CT
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City | VALLEY COTTAGE
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State | NY
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Zip | 10989-1311
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Country | US
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Telephone | 845-671-2050
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 731848-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F350073-01
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License Number State | NY
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