Provider Demographics
NPI:1750926887
Name:JOHNSON, NAKIMA
Entity type:Individual
Prefix:MRS
First Name:NAKIMA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SLEEPY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-3918
Mailing Address - Country:US
Mailing Address - Phone:856-477-2200
Mailing Address - Fax:856-818-9082
Practice Address - Street 1:35 SLEEPY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-3918
Practice Address - Country:US
Practice Address - Phone:856-447-2200
Practice Address - Fax:856-818-9082
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR4J5B7H9246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy