Provider Demographics
NPI:1003820994
Name:JOHNSON, DEANNA V (MS, RN, APN)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:V
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BROOK END DR
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1303
Mailing Address - Country:US
Mailing Address - Phone:973-325-7345
Mailing Address - Fax:973-325-3715
Practice Address - Street 1:10 BROOK END DR
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1303
Practice Address - Country:US
Practice Address - Phone:973-325-7345
Practice Address - Fax:973-325-3715
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04888600364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8036501Medicaid
NJ8036501Medicaid