MEDICARE: MS. LAURA LEE JOHNSON RN

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
1	163WG0000X	General Practice Registered Nurse	239409	OH

General Provider Information

NPI Number	:	1821503541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA LEE JOHNSON RN

Provider Business Mailing Address
First Line	:	141 BRENDEN PARK DR
Second Line	:
City	:	ETNA
State	:	OH
Zip	:	43062-8961
Country	:	US
Telephone Number	:	614-203-2214
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 BRENDEN PARK DR
Second Line	:
City	:	ETNA
State	:	OH
Zip	:	43062-8961
Country	:	US
Telephone Number	:	614-203-2214
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2017
Last Update Date	:	12/04/2017

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