Provider Demographics
NPI:1083286751
Name:JOHNSON, MICHELLE L (RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N MEADOW RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:NJ
Mailing Address - Zip Code:08270-3018
Mailing Address - Country:US
Mailing Address - Phone:609-374-2539
Mailing Address - Fax:
Practice Address - Street 1:1580 ROUTE 9 N
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-1416
Practice Address - Country:US
Practice Address - Phone:609-846-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09433500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse