Connie D Habersham-Johnson, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

26NP03799200 Issued in NJ

Practice address

2250 Hickory Rd
Suite 216
Plymouth, PA 19462

Phone

(800) 950-6066

Fax

(609) 387-7540

NPI assigned

Jul 26, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Connie D Habersham Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209081600000",
    "number": "1770773749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 CONNECTICUT DR",
            "address_2": "STE 5",
            "city": "BURLINGTON",
            "state": "NJ",
            "postal_code": "080160151",
            "telephone_number": "856-785-8109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2250 HICKORY RD",
            "address_2": "SUITE 216",
            "city": "PLYMOUTH",
            "state": "PA",
            "postal_code": "19462",
            "telephone_number": "800-950-6066",
            "fax_number": "609-387-7540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HABERSHAM-JOHNSON",
        "first_name": "CONNIE",
        "middle_name": "D",
        "name_prefix": "Miss",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-26",
        "last_updated": "2008-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NJ",
            "license": "26NP03799200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONNIE",
            "last_name": "HABERSHAM",
            "middle_name": "D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Licensed Practical Nurse in Plymouth, PA
• Providers in Plymouth, PA by specialty
• Licensed Practical Nurse in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.