Provider Demographics
NPI:1356507263
Name:JOHNSON, AMY L (RN)
Entity Type:Individual
Prefix:MS
First Name:AMY
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 1:1428 CLYMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:NY
Mailing Address - Zip Code:14724-9732
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 E CHAUTAUQUA ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-1009
Practice Address - Country:US
Practice Address - Phone:716-753-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22500227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse