MEDICARE: MR. ELTON EDWARD JOHNSON JR. 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	163WG0000X	General Practice Registered Nurse	583059	TX
2	163WP2201X	Ambulatory Care Registered Nurse	45098	HI
3	164X00000X	Licensed Vocational Nurse	69774	TX
4	363LF0000X	Family Nurse Practitioner	675	HI

General Provider Information

NPI Number	:	1508844861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ELTON EDWARD JOHNSON JR. APRN

Provider Business Mailing Address
First Line	:	98-139 KANUKU ST
Second Line	:	APT 109
City	:	AIEA
State	:	HI
Zip	:	96701-5123
Country	:	US
Telephone Number	:	808-488-1237
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SAND ISLAND PKWY
Second Line	:	USCG
City	:	HONOLULU
State	:	HI
Zip	:	96819-4326
Country	:	US
Telephone Number	:	808-842-2930
Fax Number	:	808-832-3281

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

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	09/11/2025

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