MEDICARE: MS. VERONIQUE VIDA JOHNSON CRNP

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	363LF0000X	Family Nurse Practitioner	R079962	MD

General Provider Information

NPI Number	:	1619975372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VERONIQUE VIDA JOHNSON CRNP

Provider Business Mailing Address
First Line	:	4 ROCKY LN
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-2366
Country	:	US
Telephone Number	:	410-655-8408
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 DIVISION ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21217-3121
Country	:	US
Telephone Number	:	410-383-8300
Fax Number	:

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	04/01/2025

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