Provider Demographics
NPI:1760234769
Name:JOHNSON, CHARLOTTE
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 SHORE FRONT PKWY APT 12R
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2623
Mailing Address - Country:US
Mailing Address - Phone:310-985-9189
Mailing Address - Fax:
Practice Address - Street 1:105-08 CROSSBAY BLVD
Practice Address - Street 2:PMB1012
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2623
Practice Address - Country:US
Practice Address - Phone:310-985-9189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula