Provider Demographics
NPI:1821350794
Name:JOHNS, DENISE
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JOHNS
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 1:835 BROADWAY AVE APT 15B
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4925
Mailing Address - Country:US
Mailing Address - Phone:631-220-1126
Mailing Address - Fax:
Practice Address - Street 1:835 BROADWAY AVE APT 15B
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4925
Practice Address - Country:US
Practice Address - Phone:631-220-1126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297567-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse