Individual
CAROLYN AMANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
422 E 35TH ST, BROOKLYN, NY 11203-5010
(646) 404-1293
Mailing address
422 E 35TH ST, BROOKLYN, NY 11203-5010
(646) 404-1293
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
307502-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
QV76030U
—
NY
Enumeration date
03/03/2012
Last updated
03/03/2012
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