MEDICARE: MR. DAVID VERNON JOHNSON RN/EMT

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	163WE0003X	Emergency Registered Nurse	R187894	MD
2	364SE0003X	Emergency Clinical Nurse Specialist	CS00180	MD

General Provider Information

NPI Number	:	1215520416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID VERNON JOHNSON RN/EMT

Provider Business Mailing Address
First Line	:	7753 ROCKANNA RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-2336
Country	:	US
Telephone Number	:	443-790-8703
Fax Number	:

Provider Business Practice Location Address
First Line	:	7753 ROCKANNA RD
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-2336
Country	:	US
Telephone Number	:	144-379-0870
Fax Number	:

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

Provider Enumeration Date	:	02/18/2021
Last Update Date	:	09/03/2024

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Directions to “ MR. DAVID VERNON JOHNSON RN/EMT” Practice Location

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