Provider Demographics
NPI:1417005695
Name:JOHNSON, LORNA M
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-2432
Mailing Address - Country:US
Mailing Address - Phone:323-588-0084
Mailing Address - Fax:
Practice Address - Street 1:1201 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-2432
Practice Address - Country:US
Practice Address - Phone:323-588-0084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN303602363LP2300X
CANMW1068363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANMW010681Medicaid
CANMW010680Medicaid
CARN 303602Medicaid
CAWNM1068BMedicare ID - Type UnspecifiedCNM
CANMW010681Medicaid
CAWNM1068AMedicare ID - Type UnspecifiedCNM