Provider Demographics
NPI:1902652514
Name:SWEET, JOHANNA ELIZABETH (RN)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ELIZABETH
Last Name:SWEET
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4555
Mailing Address - Country:US
Mailing Address - Phone:828-279-0838
Mailing Address - Fax:
Practice Address - Street 1:352 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4555
Practice Address - Country:US
Practice Address - Phone:828-279-0838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA266607163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics