Provider Demographics
NPI:1134503006
Name:JOHNSON, TRICIA (RN)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
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 1:106 W 3RD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5105
Mailing Address - Country:US
Mailing Address - Phone:716-484-7101
Mailing Address - Fax:
Practice Address - Street 1:106 W 3RD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5105
Practice Address - Country:US
Practice Address - Phone:716-484-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488199-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health