Healthcare Provider Details

I. General information

NPI: 1679295943
Provider Name (Legal Business Name): JOHNNA DEAN LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 TRICORN RD
DANVILLE WV
25053-7148
US

IV. Provider business mailing address

298 TRICORN RD
DANVILLE WV
25053-7148
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1385
  • Fax: 304-369-9684
Mailing address:
  • Phone: 304-369-1385
  • Fax: 304-369-9684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: