Provider Demographics
NPI:1235231531
Name:JOHNSON, CYNTHIA DIANE (NP, MSN, RN)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP, MSN, RN
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 DORANTES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1432
Mailing Address - Country:US
Mailing Address - Phone:415-665-4528
Mailing Address - Fax:
Practice Address - Street 1:1001 POTRERO AVE RM 3A36
Practice Address - Street 2:ORTHOPAEDIC SURGERY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:415-206-8812
Practice Address - Fax:415-647-3733
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN244711163WM0705X
CANPF15235363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical