Provider Demographics
NPI:1790713972
Name:JOHNSON, ANN SALVATORE (ANP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:SALVATORE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:KERHONKSON
Mailing Address - State:NY
Mailing Address - Zip Code:12446-1904
Mailing Address - Country:US
Mailing Address - Phone:845-943-6404
Mailing Address - Fax:
Practice Address - Street 1:240 S RIVERSIDE RD
Practice Address - Street 2:HIGHLAND FAMILY HEALTH
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2523
Practice Address - Country:US
Practice Address - Phone:845-691-9200
Practice Address - Fax:845-691-3992
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30-304371363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJONP2654Medicare ID - Type UnspecifiedPROVIDER NUMBER