Provider Demographics
NPI:1467105601
Name:JOHNSON, PATRICE SHEREE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PATRICE
Middle Name:SHEREE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 CHESTER PIKE STE 301
Mailing Address - Street 2:
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1471
Mailing Address - Country:US
Mailing Address - Phone:267-453-6899
Mailing Address - Fax:
Practice Address - Street 1:1510 CHESTER PIKE STE 301
Practice Address - Street 2:
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1471
Practice Address - Country:US
Practice Address - Phone:267-453-6899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN531692163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP1700XNursing Service ProvidersRegistered NursePerinatal