Individual
MINI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
197 HALF HOLLOW RD, DIX HILLS, NY 11746-5859
(631) 370-1694
Mailing address
197 HALF HOLLOW RD, DIX HILLS, NY 11746-5861
(631) 370-1700
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
781032-01
NY
Other
Enumeration date
09/22/2022
Last updated
09/22/2022
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