Provider Demographics
NPI:1659844199
Name:JOHNSON, BRENDA (CRNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:JOHNSON
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:PO BOX 67536
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-8009
Mailing Address - Country:US
Mailing Address - Phone:302-866-2494
Mailing Address - Fax:302-487-1167
Practice Address - Street 1:200 BANNING ST STE 280
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3489
Practice Address - Country:US
Practice Address - Phone:302-866-2494
Practice Address - Fax:302-487-1167
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF11180497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily