Most Relevant Information
Provider Data
| NPI Number: | 1003042367 |
| Provider Name: | BRANDY NICOLE JOHNSON LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 10 273949 |
Most Important Dates
| Enumeration Date: | 06/01/2009 |
| Last Updated: | 06/01/2009 |
Provider Practice Location
58 BERT HOWARD DR
CENTRAL SQUARE
NY
130362391
Practice Location Phone/Fax
| Phone: | 3154504577 |
| Fax: | 3156681346 |
Provider Mailing Location
58 BERT HOWARD DR
CENTRAL SQUARE
NY
130362391
Provider Mailing Phone/Fax
| Phone: | 3154504577 |
| Fax: | 3156681346 |