Healthcare Provider Details

I. General information

NPI: 1093401432
Provider Name (Legal Business Name): HEATHER LEE JOHNSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER LEE PETERS

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5351 MITCHAW RD
SYLVANIA OH
43560-9406
US

IV. Provider business mailing address

5351 MITCHAW RD
SYLVANIA OH
43560-9406
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-6699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: