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NPI Code Detail

MEDICARE: GLORIA ELIZABETH JOHNSON

MEDICARE:   GLORIA ELIZABETH JOHNSON
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
1164W00000XLicensed Practical Nurse258904NY

General Provider Information

NPI Number : 1174845531
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLORIA ELIZABETH JOHNSON
Provider Business Mailing Address
First Line : 1383 ALBANY AVE
Second Line : BROOKLYN
City : BROOKLYN
State : NY
Zip : 11203-5637
Country : US
Telephone Number : 347-663-3389
Fax Number :
Provider Business Practice Location Address
First Line : 1383 ALBANY AVE
Second Line : BROOKLYN
City : BROOKLYN
State : NY
Zip : 11203-5637
Country : US
Telephone Number : 347-663-3389
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2010
Last Update Date : 02/25/2010

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Directions to “ GLORIA ELIZABETH JOHNSON ” Practice Location

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