Provider Demographics
NPI:1720245145
Name:JOHNSON, WILLIAM HOWARD (RN, CCRC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HOWARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN, CCRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 ACORN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16423-2610
Mailing Address - Country:US
Mailing Address - Phone:814-774-3376
Mailing Address - Fax:
Practice Address - Street 1:2626 ACORN DR
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:PA
Practice Address - Zip Code:16423-2610
Practice Address - Country:US
Practice Address - Phone:814-774-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN234385L163W00000X
VA0001116850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse