Healthcare Provider Details

I. General information

NPI: 1306603717
Provider Name (Legal Business Name): MEAMI JOHNSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 S GRAND CANYON DR STE 226
LAS VEGAS NV
89147-7162
US

IV. Provider business mailing address

6572 GOLDENCREEK WAY
LAS VEGAS NV
89108-4485
US

V. Phone/Fax

Practice location:
  • Phone: 702-751-0356
  • Fax:
Mailing address:
  • Phone: 725-309-7211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number887099
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: