Provider Demographics
NPI:1134367006
Name:JOHNSON, CATHY LYNNE (NP)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-0061
Mailing Address - Country:US
Mailing Address - Phone:978-697-0838
Mailing Address - Fax:978-887-1971
Practice Address - Street 1:87 HERRICK ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2773
Practice Address - Country:US
Practice Address - Phone:978-921-1392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152734364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health