Provider Demographics
NPI:1972391365
Name:JOHNSON, ADRIENNE T (CNA,MA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:T
Last Name:JOHNSON
Suffix:
Gender:
Credentials:CNA,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 GASLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-3367
Mailing Address - Country:US
Mailing Address - Phone:929-480-5740
Mailing Address - Fax:
Practice Address - Street 1:415 GASLIGHT LN
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-3367
Practice Address - Country:US
Practice Address - Phone:929-480-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant