MEDICARE: RACQUEL JOHNSON LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	134896	OH
2	164X00000X	Licensed Vocational Nurse	134896	OH

General Provider Information

NPI Number	:	1043653322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACQUEL JOHNSON LPN

Provider Business Mailing Address
First Line	:	4202 ASBURY DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1806
Country	:	US
Telephone Number	:	419-269-8270
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 ASBURY DR
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1806
Country	:	US
Telephone Number	:	419-269-8270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2013
Last Update Date	:	04/16/2013

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