MEDICARE: LISA DARNELL JONES-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	164W00000X	Licensed Practical Nurse	930702	LA

General Provider Information

NPI Number	:	1689845042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA DARNELL JONES-JOHNSON LPN

Provider Business Mailing Address
First Line	:	9656 CHINN ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-3830
Country	:	US
Telephone Number	:	225-757-6419
Fax Number	:	225-926-0595

Provider Business Practice Location Address
First Line	:	9656 CHINN ST
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70807-3830
Country	:	US
Telephone Number	:	225-757-6419
Fax Number	:	225-926-0595

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

Provider Enumeration Date	:	03/13/2008
Last Update Date	:	03/13/2008

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