Provider Demographics
NPI:1215370283
Name:WELLINGTON, JOHANNA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:WELLINGTON
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 1:423 ASHFORD ST
Mailing Address - Street 2:APT 2
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-4403
Mailing Address - Country:US
Mailing Address - Phone:917-474-7756
Mailing Address - Fax:
Practice Address - Street 1:423 ASHFORD ST
Practice Address - Street 2:APT 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-4403
Practice Address - Country:US
Practice Address - Phone:917-474-7756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY666552163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse