MEDICARE: MRS. CLAUDIA VICTORIA CANO JOHNSON N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	RN135756	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013963024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLAUDIA VICTORIA CANO JOHNSON N.P.

Provider Business Mailing Address
First Line	:	1639 ACADEMY SQ
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-1404
Country	:	US
Telephone Number	:	404-766-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	2739 FELTON DR
Second Line	:
City	:	EAST POINT
State	:	GA
Zip	:	30344-3603
Country	:	US
Telephone Number	:	404-766-8371
Fax Number	:	404-767-3926

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/09/2009

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