1629367024 NPI number — MRS. WENDY MARIE JOHNSON FNP

Table of content: MRS. WENDY MARIE JOHNSON FNP (NPI 1629367024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629367024 NPI number — MRS. WENDY MARIE JOHNSON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
WENDY
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1629367024
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 MAIN ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
CATSKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12414-1363
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-719-3580
Provider Business Mailing Address Fax Number:
518-719-3797

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
CATSKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-719-3580
Provider Business Practice Location Address Fax Number:
518-719-3797
Provider Enumeration Date:
04/06/2011

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: 163WW0101X , with the licence number:  536360-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 343224 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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