Provider Demographics
NPI:1023309663
Name:JOHNSON, CARLETTA FAYE (BSN, RN)
Entity type:Individual
Prefix:MRS
First Name:CARLETTA
Middle Name:FAYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 TAFT DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-4160
Mailing Address - Country:US
Mailing Address - Phone:757-372-2033
Mailing Address - Fax:
Practice Address - Street 1:404 TAFT DR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-4160
Practice Address - Country:US
Practice Address - Phone:757-372-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-01
Last Update Date:2011-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001204119163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical