MEDICARE: MS. JAHNIQUE SACKIYA JOHNSON WHNP

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	F421693	NY

General Provider Information

NPI Number	:	1114797933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JAHNIQUE SACKIYA JOHNSON WHNP

Provider Business Mailing Address
First Line	:	828 E 215TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-5813
Country	:	US
Telephone Number	:	332-209-9226
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 E 215TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-5813
Country	:	US
Telephone Number	:	332-209-9226
Fax Number	:

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

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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