MEDICARE: KAWANA 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
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1518732452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAWANA JOHNSON

Provider Business Mailing Address
First Line	:	233 EASTERN PKWY FL 1
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07106-3405
Country	:	US
Telephone Number	:	862-237-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 EASTERN PKWY FL 1
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07106-3405
Country	:	US
Telephone Number	:	862-237-1410
Fax Number	:

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

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/21/2023

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Directions to “ KAWANA JOHNSON ” Practice Location

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