Provider Demographics
NPI:1336941103
Name:JOHNSON, DELESA (REGISTER NURSE)
Entity type:Individual
Prefix:
First Name:DELESA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 WOOD ARBOR PKWY APT 107
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-3416
Mailing Address - Country:US
Mailing Address - Phone:731-431-1712
Mailing Address - Fax:
Practice Address - Street 1:595 WOOD ARBOR PKWY APT 107
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-3416
Practice Address - Country:US
Practice Address - Phone:731-431-1712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000156887163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse