Provider Demographics
NPI:1609329119
Name:JOHNSON-NULL, MONICA F (CRNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:F
Last Name:JOHNSON-NULL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:REINHOLDS
Mailing Address - State:PA
Mailing Address - Zip Code:17569-9515
Mailing Address - Country:US
Mailing Address - Phone:717-314-4313
Mailing Address - Fax:
Practice Address - Street 1:80 W WELSCH POOL ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:215-876-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN613028163W00000X
PASP016653363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily