MEDICARE: MRS. MARY PORTERFIELD 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
1	163WC1500X	Community Health Registered Nurse	RN-46072	HI

General Provider Information

NPI Number	:	1831186998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY PORTERFIELD JOHNSON RN

Provider Business Mailing Address
First Line	:	4515 PRINCETON PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5044
Country	:	US
Telephone Number	:	808-455-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 PRINCETON PL
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96818-5044
Country	:	US
Telephone Number	:	808-455-5981
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	07/08/2007

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