Healthcare Provider Details

I. General information

NPI: 1154651891
Provider Name (Legal Business Name): TAUNYA LLVERTRICE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAUNYA LLVERTRICE JOHNSON RN

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 01/30/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ESTATE CT
ORANGEBURG SC
29115-8197
US

IV. Provider business mailing address

20 ESTATE CT
ORANGEBURG SC
29115-8197
US

V. Phone/Fax

Practice location:
  • Phone: 803-878-2389
  • Fax:
Mailing address:
  • Phone: 803-878-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number574725-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number62887
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: