MEDICARE: ISATU ISABELLE JOHNSON NURSE PRACTITIONER

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	26NR17118800	NJ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15288000	NJ

General Provider Information

NPI Number	:	1750771549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISATU ISABELLE JOHNSON NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	200 SURF RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-8115
Country	:	US
Telephone Number	:	856-534-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 SURF RD
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-8115
Country	:	US
Telephone Number	:	856-534-9093
Fax Number	:

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

Provider Enumeration Date	:	01/31/2015
Last Update Date	:	02/20/2026

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