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General NPI Number Information
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NPI Number | 1023825619
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Entity Type | Individual
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Provider Name | SAMYRA JOHNSON LPN
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 11531 PLANEWOOD CT UNIT HMOFC
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-3630
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Country | US
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Telephone | 317-222-8953
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Fax |
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Provider Business Mailing Address
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Address Line | 5625 N GERMAN CHURCH RD UNIT 2245
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City | INDIANAPOLIS
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State | IN
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Zip | 46235-8513
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Country | US
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Telephone | 317-537-7844
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Fax |
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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 | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 27074787A
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License Number State | IN
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