Healthcare Provider Details

I. General information

NPI: 1780647503
Provider Name (Legal Business Name): DOROTHY L. JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 MEADOW LN
RHINELANDER WI
54501-8816
US

IV. Provider business mailing address

3855 MEADOW LN
RHINELANDER WI
54501-8816
US

V. Phone/Fax

Practice location:
  • Phone: 715-369-3784
  • Fax: 715-369-3784
Mailing address:
  • Phone: 715-369-3784
  • Fax: 715-369-3784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number93176-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: