MEDICARE: DEBRA V JOHNSON APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	000838	CT

General Provider Information

NPI Number	:	1427056472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA V JOHNSON APRN

Provider Business Mailing Address
First Line	:	22 TRAINOR DR
Second Line	:
City	:	WEATOGUE
State	:	CT
Zip	:	06089-9613
Country	:	US
Telephone Number	:	860-983-0655
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 TOWER LN STE 104
Second Line	:
City	:	AVON
State	:	CT
Zip	:	06001-4237
Country	:	US
Telephone Number	:	860-983-0655
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	04/26/2022

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