Provider Demographics
NPI:1669748042
Name:JOHNSON, ENA VERONICA (200816 RN)
Entity type:Individual
Prefix:MISS
First Name:ENA
Middle Name:VERONICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:200816 RN
Other - Prefix:
Other - First Name:ENA
Other - Middle Name:VERONICA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1220 GERARD AVE
Mailing Address - Street 2:BRONX NEW YORK
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8099
Mailing Address - Country:US
Mailing Address - Phone:718-410-7698
Mailing Address - Fax:718-588-3128
Practice Address - Street 1:1220 GERARD AVE
Practice Address - Street 2:BRONX NEW YORK
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8099
Practice Address - Country:US
Practice Address - Phone:718-410-7698
Practice Address - Fax:718-588-3128
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20816390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program