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General NPI Number Information
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NPI Number | 1578764965
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Entity Type | Individual
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Provider Name | MR. HENDERSON JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 SOUTH COURT ST
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City | OPELOUSAS
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State | LA
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Zip | 70570
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Country | US
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Telephone | 337-948-4481
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Fax | 337-948-4437
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Provider Business Mailing Address
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Address Line | PO BOX 671
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City | OPELOUSAS
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State | LA
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Zip | 70571-0671
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Country | US
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Telephone | 337-948-4481
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Fax | 337-948-4437
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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 | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number | CLP.200901-PHL
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License Number State | LA
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