Healthcare Provider Details

I. General information

NPI: 1770843468
Provider Name (Legal Business Name): LENA ELIZABETH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 WALNUT ST
RED BLUFF CA
96080-3611
US

IV. Provider business mailing address

1860 WALNUT ST.
RED BLUFF CA
96080
US

V. Phone/Fax

Practice location:
  • Phone: 530-527-5637
  • Fax: 530-527-0249
Mailing address:
  • Phone: 530-527-5637
  • Fax: 530-527-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: