1669748042 NPI number — MISS ENA VERONICA JOHNSON 200816 RN

Table of content: MISS ENA VERONICA JOHNSON 200816 RN (NPI 1669748042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669748042 NPI number — MISS ENA VERONICA JOHNSON 200816 RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ENA
Provider Middle Name:
VERONICA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
200816 RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
ENA
Provider Other Middle Name:
VERONICA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
REGISTERED NURSE
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1669748042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 GERARD AVE
Provider Second Line Business Mailing Address:
BRONX NEW YORK
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10452-8099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-410-7698
Provider Business Mailing Address Fax Number:
718-588-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 GERARD AVE
Provider Second Line Business Practice Location Address:
BRONX NEW YORK
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10452-8099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-410-7698
Provider Business Practice Location Address Fax Number:
718-588-3128
Provider Enumeration Date:
03/29/2012

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: 390200000X , with the licence number:  20816 , 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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