Provider Demographics
NPI:1497188593
Name:JOHNSON, ROSEMARY (APRN)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 NORWICH WESTERLY RD
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1128
Mailing Address - Country:US
Mailing Address - Phone:860-312-8000
Mailing Address - Fax:860-312-8001
Practice Address - Street 1:75 NORWICH WESTERLY RD
Practice Address - Street 2:
Practice Address - City:LEDYARD
Practice Address - State:CT
Practice Address - Zip Code:06339-1128
Practice Address - Country:US
Practice Address - Phone:860-312-8000
Practice Address - Fax:860-312-8001
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE59244163W00000X
CT002299363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse