Provider Demographics
NPI:1285229302
Name:JOHNSON, VICTORIA LYN (CST/CSFA)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:LYN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST/CSFA
Mailing Address - Street 1:401 O TOOLE DR
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-9496
Mailing Address - Country:US
Mailing Address - Phone:708-937-8337
Mailing Address - Fax:
Practice Address - Street 1:401 O TOOLE DR
Practice Address - Street 2:
Practice Address - City:MINOOKA
Practice Address - State:IL
Practice Address - Zip Code:60447-9496
Practice Address - Country:US
Practice Address - Phone:708-937-8337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant