Healthcare Provider Details

I. General information

NPI: 1922710169
Provider Name (Legal Business Name): LASHELLE S JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

IV. Provider business mailing address

121 S LONG BEACH BLVD
COMPTON CA
90221-3423
US

V. Phone/Fax

Practice location:
  • Phone: 504-400-1460
  • Fax:
Mailing address:
  • Phone: 310-627-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95021289
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: