Johnson, Diane

Johnson, Diane is an individual health care provider with primary practice located at 365 Montauk Ave Northeast Medical Group, Inc., New London CT 06320-4700. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Acute Care. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Johnson, Diane can be contacted via phone (860) 442-0711.

Contact Information

Primary practice address
365 Montauk Ave Northeast Medical Group, Inc. New London CT 06320-4700
Phone: (860) 442-0711
Fax: (860) 444-5114
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 2409 Connecticut
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X 002409 Connecticut

Profile Details

NPI number 1316957285
LBN Legal business name Johnson, Diane
Credentials PMHNP (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 9th, 2006
Last updated Dec 7th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316957285 NPPES
Connecticut MEDICAID 1316957285
Connecticut MEDICAID 1316957285

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