1457566135 NPI number — MS. CINDY JO JOHNSON APRN/BC

Table of content: MS. CINDY JO JOHNSON APRN/BC (NPI 1457566135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457566135 NPI number — MS. CINDY JO JOHNSON APRN/BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CINDY
Provider Middle Name:
JO
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN/BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457566135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
469 CENTERVILLE ROAD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
WARWICK
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02886-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-773-3700
Provider Business Mailing Address Fax Number:
401-773-3701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
469 CENTERVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WARWICK
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02886-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-773-3700
Provider Business Practice Location Address Fax Number:
401-773-3701
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X , with the licence number:  26NJ00095300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: APRN01953 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 383882 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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