Healthcare Provider Details

I. General information

NPI: 1316597875
Provider Name (Legal Business Name): TONIKA JOHNSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 MONTICELLO BLVD
RICHMOND HEIGHTS OH
44143-2847
US

IV. Provider business mailing address

4933 MONTICELLO BLVD
RICHMOND HEIGHTS OH
44143-2847
US

V. Phone/Fax

Practice location:
  • Phone: 216-224-4113
  • Fax:
Mailing address:
  • Phone: 216-224-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number162776
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number36D2190656
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: