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General NPI Number Information
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NPI Number | 1013893858
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Entity Type | Individual
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Provider Name | JOLENE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 712 1ST AVE S
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City | LAKE NORDEN
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State | SD
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Zip | 57248-3205
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Country | US
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Telephone | 605-520-5868
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Fax | 605-785-3320
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Provider Business Mailing Address
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Address Line | 802 1ST AVE S # 229
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City | LAKE NORDEN
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State | SD
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Zip | 57248-3206
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Country | US
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Telephone | 605-520-5868
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Fax | 605-785-3320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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