Healthcare Provider Details

I. General information

NPI: 1649969460
Provider Name (Legal Business Name): OLIVIA LEE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 E BARSTOW AVE STE 102
FRESNO CA
93710-6039
US

IV. Provider business mailing address

347 E BARSTOW AVE STE 102
FRESNO CA
93710-6039
US

V. Phone/Fax

Practice location:
  • Phone: 559-550-4344
  • Fax: 559-550-6011
Mailing address:
  • Phone: 559-550-4344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number95224230
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027393
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: