Individual
BALEISHA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP, ANP-BC
Contact information
Practice address
2015 GRAND CONCOURSE, BRONX, NY 10453
(718) 299-7295
Mailing address
3198 GRAND CONCOURSE, BRONX, NY 10458-1000
(718) 618-0401
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
305445
NY
363LG0600X
Gerontology Nurse Practitioner
340774
NY
Other
Enumeration date
07/29/2010
Last updated
01/22/2019
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