Provider Demographics
NPI:1215520416
Name:JOHNSON, DAVID VERNON (RN/EMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:VERNON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN/EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7753 ROCKANNA RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2336
Mailing Address - Country:US
Mailing Address - Phone:443-790-8703
Mailing Address - Fax:
Practice Address - Street 1:7753 ROCKANNA RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2336
Practice Address - Country:US
Practice Address - Phone:144-379-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187894163WE0003X
MDCS00180364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
No163WE0003XNursing Service ProvidersRegistered NurseEmergency