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General NPI Number Information
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NPI Number | 1902120082
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Entity Type | Individual
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Provider Name | RENE JOHNSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 03/18/2010
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 173 SAINT PATRICKS DR STE 104
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City | WALDORF
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State | MD
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Zip | 20603-5530
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 173 SAINT PATRICKS DR STE 104
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City | WALDORF
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State | MD
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Zip | 20603-5530
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Country | US
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Telephone | 888-731-8994
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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 | R134332
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | R134332
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License Number State | MD
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