Provider Demographics
NPI:1285251645
Name:JOHNSON, NATALIE (LVN)
Entity type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:
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 1:1322 FAIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75134-4160
Mailing Address - Country:US
Mailing Address - Phone:214-471-5391
Mailing Address - Fax:
Practice Address - Street 1:1322 FAIRFIELD CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-4160
Practice Address - Country:US
Practice Address - Phone:214-471-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX300691164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX500016353Medicaid