Basic Information
| Provider Information | |||||||||
| NPI: | 1568809887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | PATRICIA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 174 | ||||||||
| Address2: | |||||||||
| City: | EAST WAREHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025380174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7746418234 | ||||||||
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| Practice Location | |||||||||
| Address1: | 88 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | TAUNTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027802465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088287000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2013 | ||||||||
| LastUpdateDate: | 07/25/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 4733 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.