MEDICARE: BOBBIE JO JOHNSON LPN, MLT

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	138459	OH
2	246RM2200X	Medical Laboratory Technician	52455	OH

General Provider Information

NPI Number	:	1487976775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOBBIE JO JOHNSON LPN, MLT

Provider Business Mailing Address
First Line	:	3645 BROOKLINE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-3406
Country	:	US
Telephone Number	:	614-353-9700
Fax Number	:	614-445-7047

Provider Business Practice Location Address
First Line	:	3645 BROOKLINE AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-3406
Country	:	US
Telephone Number	:	614-353-9700
Fax Number	:	614-445-7047

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

Provider Enumeration Date	:	02/27/2010
Last Update Date	:	02/27/2010

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