1467589267 NPI number — THELMA ELAINE JOHNSON RN.,RNFA

Table of content: THELMA ELAINE JOHNSON RN.,RNFA (NPI 1467589267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467589267 NPI number — THELMA ELAINE JOHNSON RN.,RNFA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
THELMA
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN.,RNFA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467589267
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
849 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
#205
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-3079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-630-4467
Provider Business Mailing Address Fax Number:
561-630-4467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 45TH ST
Provider Second Line Business Practice Location Address:
COLUMBIA HOSPITAL
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-863-3855
Provider Business Practice Location Address Fax Number:
561-881-5474
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  RN1475272 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Y6109 . This is a "BLUE CROSS BLUESHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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