Individual
MR. TREVOR R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
367 E MAIN ST STE A, WATERLOO, NY 13165-1643
(315) 787-4977
Mailing address
4603 WITHERDEN RD, MARION, NY 14505-9319
(585) 278-8583
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
F357797-01
NY
Other
Enumeration date
10/07/2025
Last updated
10/07/2025
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