Provider Demographics
NPI:1467723171
Name:JOHNSON, EILEEN C
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:C
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 1:1626 BALLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2304
Mailing Address - Country:US
Mailing Address - Phone:518-382-2511
Mailing Address - Fax:518-382-2524
Practice Address - Street 1:1626 BALLTOWN RD
Practice Address - Street 2:
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-2304
Practice Address - Country:US
Practice Address - Phone:518-382-2511
Practice Address - Fax:518-382-2524
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203191163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool