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General NPI Number Information
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NPI Number | 1982070728
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Entity Type | Individual
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Provider Name | MRS. NICOLA M JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 08/17/2015
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Provider Practice Location Address
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Address Line | 300 ASHFORD ST
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City | BROOKLYN
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State | NY
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Zip | 11207-3204
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Country | US
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Telephone | 718-235-3478
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Fax |
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Provider Business Mailing Address
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Address Line | 300 ASHFORD ST
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City | BROOKLYN
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State | NY
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Zip | 11207-3204
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Country | US
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Telephone | 718-235-3478
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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 | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State | NY
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