Individual
PORTIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4400 VESTAL PKWY E, BINGHAMTON, NY 13902-4400
(607) 777-3711
Mailing address
3 CLUBHOUSE RD, BINGHAMTON, NY 13903-1208
(607) 727-7772
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
402707
NY
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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