MEDICARE: RONTASHA 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	164W00000X	Licensed Practical Nurse	19778	NE

General Provider Information

NPI Number	:	1144822776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONTASHA JOHNSON

Provider Business Mailing Address
First Line	:	1534 N 20TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2373
Country	:	US
Telephone Number	:	402-415-9639
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 N 20TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-2373
Country	:	US
Telephone Number	:	402-415-9639
Fax Number	:

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

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/09/2020

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Directions to “ RONTASHA JOHNSON ” Practice Location

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