Individual
BRANDY NICOLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
58 BERT HOWARD DR, CENTRAL SQUARE, NY 13036-2391
(315) 450-4577
(315) 668-1346
Mailing address
58 BERT HOWARD DR, CENTRAL SQUARE, NY 13036-2391
(315) 450-4577
(315) 668-1346
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
033832
CT
164W00000X
Licensed Practical Nurse
Primary
10 273949
NY
Other
Enumeration date
06/01/2009
Last updated
06/01/2009
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