Provider Demographics
NPI:1124273255
Name:JOHNSON, ANTOINETTE MICHELLE (LVN)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MICHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 1/2 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-3642
Mailing Address - Country:US
Mailing Address - Phone:661-321-0234
Mailing Address - Fax:661-321-9856
Practice Address - Street 1:2614 TROPICAL AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2205
Practice Address - Country:US
Practice Address - Phone:661-663-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN187929164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse