Provider Demographics
NPI:1073848388
Name:JOHNSON, DARREN PAUL (RN)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:PAUL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SHELLY LN
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-6423
Mailing Address - Country:US
Mailing Address - Phone:516-495-4945
Mailing Address - Fax:
Practice Address - Street 1:24 SHELLY LN
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-6423
Practice Address - Country:US
Practice Address - Phone:516-495-4945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY502804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse