MEDICARE: MR. WILLIAM HOWARD JOHNSON RN, CCRC

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	163W00000X	Registered Nurse	RN234385L	PA
2	163W00000X	Registered Nurse	0001116850	VA

General Provider Information

NPI Number	:	1720245145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM HOWARD JOHNSON RN, CCRC

Provider Business Mailing Address
First Line	:	2626 ACORN DRIVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-2610
Country	:	US
Telephone Number	:	814-774-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	2626 ACORN DR
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-2610
Country	:	US
Telephone Number	:	814-774-3376
Fax Number	:

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

Provider Enumeration Date	:	05/22/2008
Last Update Date	:	05/22/2008

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