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NPI Code Detail

MEDICARE: LYNESE BETH JOHNSON LPN

MEDICARE: LYNESE BETH JOHNSON LPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical Nurse134825OH

General Provider Information

NPI Number : 1205594231
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNESE BETH JOHNSON LPN
Provider Business Mailing Address
First Line : 1415 SALEM AVE
Second Line :
City : DAYTON
State : OH
Zip : 45406-4941
Country : US
Telephone Number : 937-380-2418
Fax Number : 937-795-3403
Provider Business Practice Location Address
First Line : 1415 SALEM AVE
Second Line :
City : DAYTON
State : OH
Zip : 45406-4941
Country : US
Telephone Number : 937-380-2418
Fax Number : 937-795-3403
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2021
Last Update Date : 12/07/2021

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