Provider Demographics
NPI:1790026763
Name:JOHNSON, JANE NICOLE (APRN ANP-C)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 HEDING-JACKSONVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505
Mailing Address - Country:US
Mailing Address - Phone:609-556-5551
Mailing Address - Fax:
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-267-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00417000163WW0000X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care