Provider Demographics
NPI:1700280153
Name:JOHNSON, BELINDA NICOLE (LPN)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 GARDEN ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2427
Mailing Address - Country:US
Mailing Address - Phone:845-264-8762
Mailing Address - Fax:
Practice Address - Street 1:777 WESTCHESTER AVE.
Practice Address - Street 2:MAXIM HEALTHCARE
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604
Practice Address - Country:US
Practice Address - Phone:914-997-0420
Practice Address - Fax:877-306-1432
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316238164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY316238OtherLPN