Provider Demographics
NPI:1124884606
Name:JOHNSON, LANEISHA DEWAYNA (LVN)
Entity type:Individual
Prefix:
First Name:LANEISHA
Middle Name:DEWAYNA
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 1:1676 GARLAND WAY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3223
Mailing Address - Country:US
Mailing Address - Phone:909-749-5175
Mailing Address - Fax:
Practice Address - Street 1:2999 KENDALL DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2415
Practice Address - Country:US
Practice Address - Phone:909-347-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty