Provider Demographics
NPI:1912668930
Name:JOHNSON, MONICA (LPN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21374 KIMBERLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:AL
Mailing Address - Zip Code:35111
Mailing Address - Country:US
Mailing Address - Phone:205-470-8737
Mailing Address - Fax:
Practice Address - Street 1:21374 KIMBERLY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE VIEW
Practice Address - State:AL
Practice Address - Zip Code:35111
Practice Address - Country:US
Practice Address - Phone:205-470-8737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-053486164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse