Provider Demographics
NPI:1801171343
Name:JOHNSON, JOMEL G (NURSE)
Entity type:Individual
Prefix:MS
First Name:JOMEL
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 E 219TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-5328
Mailing Address - Country:US
Mailing Address - Phone:347-720-1465
Mailing Address - Fax:
Practice Address - Street 1:822 E 219TH ST APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5328
Practice Address - Country:US
Practice Address - Phone:347-720-1465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218130164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse