Provider Demographics
NPI:1518333731
Name:JOHNSON, MINDY LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:2 ACADEMY ST RM 201
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1050
Mailing Address - Country:US
Mailing Address - Phone:716-753-4104
Mailing Address - Fax:716-753-4320
Practice Address - Street 1:200 E 3RD ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5433
Practice Address - Country:US
Practice Address - Phone:716-661-8331
Practice Address - Fax:716-661-8364
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2023-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY702216-1163W00000X
NY702216363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse