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NPI Code Detail

MEDICARE: MS. NICHELLE RYNETTE JOHNSON LPN

MEDICARE: MS. NICHELLE RYNETTE 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
1164W00000XLicensed Practical NurseLPN044382AZ

General Provider Information

NPI Number : 1386977130
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICHELLE RYNETTE JOHNSON LPN
Provider Business Mailing Address
First Line : 19522 N COMET TRL
Second Line :
City : MARICOPA
State : AZ
Zip : 85138-5814
Country : US
Telephone Number : 520-568-6036
Fax Number :
Provider Business Practice Location Address
First Line : 44150 W MARICOPA CASA GRANDE HWY
Second Line :
City : MARICOPA
State : AZ
Zip : 85138-5900
Country : US
Telephone Number : 520-568-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2009
Last Update Date : 09/11/2009

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