MEDICARE: LYNNE JOHNSON

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	163W00000X	Registered Nurse	RN 167884	OH

General Provider Information

NPI Number	:	1073938759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNNE JOHNSON

Provider Business Mailing Address
First Line	:	3013 E 130TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3005
Country	:	US
Telephone Number	:	216-751-6942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 SUPERIOR AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2522
Country	:	US
Telephone Number	:	216-431-5882
Fax Number	:

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

Provider Enumeration Date	:	03/04/2014
Last Update Date	:	03/04/2014

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Directions to “ LYNNE JOHNSON ” Practice Location

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