Provider Demographics
NPI:1962719831
Name:JOHNSON, DAWN RAQUEAL (LPN, RN)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:RAQUEAL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RED PLANK WAY
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2481
Mailing Address - Country:US
Mailing Address - Phone:585-224-6444
Mailing Address - Fax:
Practice Address - Street 1:39 RED PLANK WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2481
Practice Address - Country:US
Practice Address - Phone:585-224-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN3195664164W00000X
NY285687164W00000X
NY765207163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse