Provider Demographics
NPI:1568937753
Name:JOHNSON, KAREN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
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 1:244 W 137TH ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2416
Mailing Address - Country:US
Mailing Address - Phone:845-399-4228
Mailing Address - Fax:
Practice Address - Street 1:244 W 137TH ST APT 1R
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2416
Practice Address - Country:US
Practice Address - Phone:845-399-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558583163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse