1952417263 NPI number — MISS MARCIA ANNETTE JOHNSON CRNP

Table of content: MISS MARCIA ANNETTE JOHNSON CRNP (NPI 1952417263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952417263 NPI number — MISS MARCIA ANNETTE JOHNSON CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MARCIA
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1952417263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 WHITE CHAPEL COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT. LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-802-9976
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS
Provider Second Line Business Practice Location Address:
BLD 5437 8TH STREET
Provider Business Practice Location Address City Name:
FORT DIX
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-562-2999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/21/2006

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: 363LP2300X , with the licence number:  26NN083919 00 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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