Provider Demographics
NPI:1952973257
Name:JOHNSON, ANNETTE VERONICA (CRNP-PMH)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:VERONICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SPYCE MILL CT
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4336
Mailing Address - Country:US
Mailing Address - Phone:410-215-5442
Mailing Address - Fax:
Practice Address - Street 1:17 SPYCE MILL CT
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4336
Practice Address - Country:US
Practice Address - Phone:410-215-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188752363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health