Provider Demographics
NPI:1649540188
Name:JOHNSON, KWAMI (RN)
Entity type:Individual
Prefix:MR
First Name:KWAMI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ELLIOT PL
Mailing Address - Street 2:APT.11
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-7153
Mailing Address - Country:US
Mailing Address - Phone:646-229-5998
Mailing Address - Fax:
Practice Address - Street 1:22 ELLIOT PL
Practice Address - Street 2:APT.11
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7153
Practice Address - Country:US
Practice Address - Phone:646-229-5998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY621373-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse