=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538289442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA FAY JOHNSON LPN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44328 LAFFERTY RD
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-9791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-968-0068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 44328 LAFFERTY RD
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-9791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-968-0068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN091552
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | PN275454
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | 22696
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------