MEDICARE: JOHANNA ELIZABETH SWEET 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	163WP0200X	Pediatric Registered Nurse	266607	MA

General Provider Information

NPI Number	:	1902652514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA ELIZABETH SWEET RN

Provider Business Mailing Address
First Line	:	352 PROSPECT AVE
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-4555
Country	:	US
Telephone Number	:	828-279-0838
Fax Number	:

Provider Business Practice Location Address
First Line	:	352 PROSPECT AVE
Second Line	:
City	:	WEST SPRINGFIELD
State	:	MA
Zip	:	01089-4555
Country	:	US
Telephone Number	:	828-279-0838
Fax Number	:

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

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	04/24/2024

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