Provider Demographics
NPI:1124233473
Name:JOHNSON, THERESA M (RN BC APRN LADC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN BC APRN LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9A FARMINGTON CHASE CRESCENT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-3132
Mailing Address - Country:US
Mailing Address - Phone:860-677-0367
Mailing Address - Fax:860-677-0367
Practice Address - Street 1:361 PARK RD
Practice Address - Street 2:3RD FL
Practice Address - City:WEST HURTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119
Practice Address - Country:US
Practice Address - Phone:860-523-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLADC000161101Y00000X
CTRNE33028163W00000X
CTAPRN002487363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner