Provider Demographics
NPI:1427350628
Name:JOHNSON, LOIDA A (CRNP)
Entity type:Individual
Prefix:MS
First Name:LOIDA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:LOIDA
Other - Middle Name:A
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-2302
Mailing Address - Fax:
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190528363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD560040500Medicaid
MD972048-01OtherBLUE CROSS/BLUE SHIELD
MDS062-0417OtherBC/BS REGIONAL
MDS062-0417OtherBC/BS REGIONAL
MDP01409352Medicare PIN