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NPI Code Detail

MEDICARE: QUANDESHA JOHNSON RN

MEDICARE: QUANDESHA JOHNSON RN
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
1164W00000XLicensed Practical Nurse295418NY
2163W00000XRegistered Nurse675335NY

General Provider Information

NPI Number : 1740506823
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUANDESHA JOHNSON RN
Provider Business Mailing Address
First Line : 6339 MILL ST
Second Line :
City : RHINEBECK
State : NY
Zip : 12572-1427
Country : US
Telephone Number : 845-871-1000
Fax Number : 845-876-2020
Provider Business Practice Location Address
First Line : 6339 MILL ST
Second Line :
City : RHINEBECK
State : NY
Zip : 12572-1427
Country : US
Telephone Number : 845-871-1000
Fax Number : 845-876-2020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2010
Last Update Date : 03/16/2016

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