Provider Demographics
NPI:1831313584
Name:JOHNSON, PATRICIA LOUISE (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:LOUISE
Other - Last Name:BUNTING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:904 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-5450
Mailing Address - Country:US
Mailing Address - Phone:410-675-7078
Mailing Address - Fax:
Practice Address - Street 1:VA MARHYLAND HEALTHCARE SYSTEM
Practice Address - Street 2:3900 LOCH RAVEN BLVD BLDG 2
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218
Practice Address - Country:US
Practice Address - Phone:410-605-7636
Practice Address - Fax:410-605-7676
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR067302163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health