Provider Demographics
NPI:1760670533
Name:JOHNSON, ELLEN BRIGMAN
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:BRIGMAN
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 1:107 GRAHAM LN
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516-9449
Mailing Address - Country:US
Mailing Address - Phone:252-728-4422
Mailing Address - Fax:252-728-7909
Practice Address - Street 1:107 GRAHAM LN
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516-9449
Practice Address - Country:US
Practice Address - Phone:252-728-4422
Practice Address - Fax:252-728-7909
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL-016-007372500000X
NCFCL-016-011372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804167Medicaid
NC7804168Medicaid