Mr. Trevor R Johnson
Mr. Trevor R Johnson is a Nurse Practitioner in Waterloo, New York. Qualified in 2025, 1 year ago. Licensed in New York.
- Years since qualifying
- 1
- Licensed in
- NY
- In the registry since
- 2025
Practice location Address checks out
367 E Main St Ste AWaterloo, NY 13165-1643
Phone: (315) 787-4977
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Primary Care Nurse Practitioner (primary) | Taxonomy 363LP2300X · Licence F357797-01 (NY) |
|---|
Record details
| NPI number | 1669347951 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | No |
| NPI enumerated | October 7, 2025 |
| Last updated in NPPES | October 7, 2025 |
| Certification date | September 19, 2025 |
| Mailing address | 4603 Witherden Rd, Marion, NY 14505-9319 |
Medicare enrollment
| Medicare specialty | NURSE PRACTITIONER |
|---|---|
| Medical school | OTHER |
| Graduated | 2025 (1 years in practice) |
| Accepts Medicare assignment | Not indicated |
Other providers in Waterloo
-
Stephanie Humbert
367 E Main St, Waterloo, NY 13165-1662 · (315) 521-9228