Provider Demographics
NPI:1982880662
Name:JOHNSON, BRIAN ONEILL (LPN)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ONEILL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-3937
Mailing Address - Country:US
Mailing Address - Phone:920-573-9784
Mailing Address - Fax:
Practice Address - Street 1:515 E NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3937
Practice Address - Country:US
Practice Address - Phone:920-573-9784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-13
Last Update Date:2008-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309324-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse