MEDICARE: MR. JOHN JOHNSON LPN

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	164W00000X	Licensed Practical Nurse	290220-1	NY

General Provider Information

NPI Number	:	1376732743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN JOHNSON LPN

Provider Business Mailing Address
First Line	:	38 PROSPECT ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4514
Country	:	US
Telephone Number	:	203-947-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 PROSPECT ST
Second Line	:
City	:	RIDGEFIELD
State	:	CT
Zip	:	06877-4514
Country	:	US
Telephone Number	:	203-947-4100
Fax Number	:

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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