Provider Demographics
NPI:1073353777
Name:JOHNSON, LAURYN RUTH
Entity type:Individual
Prefix:
First Name:LAURYN
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-2439
Mailing Address - Country:US
Mailing Address - Phone:740-418-9961
Mailing Address - Fax:
Practice Address - Street 1:1327 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-2439
Practice Address - Country:US
Practice Address - Phone:740-418-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker