Provider Demographics
NPI:1811085277
Name:JOHNSON, BRENDA L (LPN)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:L
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 1:1379 NOSTRAND AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-2579
Mailing Address - Country:US
Mailing Address - Phone:212-305-3400
Mailing Address - Fax:212-342-3955
Practice Address - Street 1:60 HAVEN AVE
Practice Address - Street 2:LOBBY LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2604
Practice Address - Country:US
Practice Address - Phone:212-342-4763
Practice Address - Fax:212-342-3955
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse