Provider Demographics
NPI:1750771549
Name:JOHNSON, ISATU ISABELLE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:ISATU
Middle Name:ISABELLE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SURF RD
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-8115
Mailing Address - Country:US
Mailing Address - Phone:856-534-9093
Mailing Address - Fax:
Practice Address - Street 1:200 SURF RD
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-8115
Practice Address - Country:US
Practice Address - Phone:856-534-9093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17118800163W00000X
NJ26NJ15288000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse