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General NPI Number Information
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NPI Number | 1174334080
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Entity Type | Individual
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Provider Name | LACI NICOLE JOHNSON APRN, CNM, RDMS
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Gender | Female
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Dates
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Enumeration Date | 01/20/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 5750 PINELAND DR STE 240
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City | DALLAS
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State | TX
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Zip | 75231-5300
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Country | US
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Telephone | 214-221-0855
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Fax | 214-221-1437
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Provider Business Mailing Address
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Address Line | 5750 PINELAND DR STE 240
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City | DALLAS
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State | TX
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Zip | 75231-5300
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Country | US
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Telephone | 214-221-0855
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Fax | 214-221-1437
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1000446
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2471S1302X
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Taxonomy Name | Sonography Radiologic Technologist
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License Number | 169948
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 169948
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 1000446
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License Number State | TX
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