Provider Demographics
NPI:1265683213
Name:JOHNSON, ESMINE S
Entity Type:Individual
Prefix:MR
First Name:ESMINE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3319
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-3319
Mailing Address - Country:US
Mailing Address - Phone:914-668-3154
Mailing Address - Fax:
Practice Address - Street 1:155 CRARY AVE
Practice Address - Street 2:APT 5G
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1451
Practice Address - Country:US
Practice Address - Phone:914-668-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY420409-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse