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Individual

MRS. RAEANNE TATEM JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN,MSN,CPNP-PC

Contact information

Practice address
1005 BIG OAK CT, KNIGHTDALE, NC 27545-6565
(919) 266-5669
(919) 488-1717
Mailing address
260 HORIZON DR, RALEIGH, NC 27615-4922
(919) 488-0015
(919) 277-0066

Taxonomy

Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
20227375
NC
363LP0200X
Pediatric Nurse Practitioner
5007103
NC

Other

Enumeration date
08/19/2014
Last updated
07/11/2022
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