Provider Demographics
NPI:1891550745
Name:JOHNSON, HARLEY BEUSELINK (RN)
Entity Type:Individual
Prefix:MS
First Name:HARLEY
Middle Name:BEUSELINK
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S GLASSY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-4715
Mailing Address - Country:US
Mailing Address - Phone:864-477-8058
Mailing Address - Fax:
Practice Address - Street 1:47 FISHERMAN LN
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-5013
Practice Address - Country:US
Practice Address - Phone:855-390-6568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC231837163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse