MEDICARE: DESIREE 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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295278497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE JOHNSON LPN

Provider Business Mailing Address
First Line	:	3672 N RANCHO DRIVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130
Country	:	US
Telephone Number	:	702-343-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3672 N RANCHO DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89130-3149
Country	:	US
Telephone Number	:	702-685-1600
Fax Number	:

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

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	11/21/2016

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Directions to “ DESIREE JOHNSON LPN” Practice Location

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