Individual
PEDER JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-6000
Mailing address
28 CRESCENT ST, MIDDLETOWN, CT 06457-3654
(860) 358-6000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
8775
CT
Other
Enumeration date
05/14/2020
Last updated
02/24/2021
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