Provider Demographics
NPI:1154737138
Name:JOHNSON, CHRIS (CNA)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 E 1ST STEER
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537
Mailing Address - Country:US
Mailing Address - Phone:970-581-4394
Mailing Address - Fax:
Practice Address - Street 1:536 E 1ST ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5718
Practice Address - Country:US
Practice Address - Phone:970-581-4394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00758445376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide