Provider Demographics
NPI:1457566135
Name:JOHNSON, CINDY JO (APRN/BC)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 CENTERVILLE ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4448
Mailing Address - Country:US
Mailing Address - Phone:401-773-3700
Mailing Address - Fax:401-773-3701
Practice Address - Street 1:469 CENTERVILLE ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4448
Practice Address - Country:US
Practice Address - Phone:401-773-3700
Practice Address - Fax:401-773-3701
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00095300364SP0808X
RIAPRN01953364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ383882OtherMANAGED HEALTH NETWORK