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NPI Code Detail

MEDICARE: JOHNNA DEAN LPN

MEDICARE: JOHNNA DEAN 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
1251E00000XHome Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
121160OTHERWVLPN LICENSE

General Provider Information

NPI Number : 1679295943
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHNNA DEAN LPN
Provider Business Mailing Address
First Line : 298 TRICORN RD
Second Line :
City : DANVILLE
State : WV
Zip : 25053-7148
Country : US
Telephone Number : 304-369-1385
Fax Number : 304-369-9684
Provider Business Practice Location Address
First Line : 298 TRICORN RD
Second Line :
City : DANVILLE
State : WV
Zip : 25053-7148
Country : US
Telephone Number : 304-369-1385
Fax Number : 304-369-9684
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2022
Last Update Date : 09/14/2022

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Directions to “ JOHNNA DEAN LPN” Practice Location

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