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NPI Code Detail

MEDICARE: JERVONNE LANEE JOHNSON

MEDICARE: JERVONNE LANEE JOHNSON
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
1363LF0000XFamily Nurse Practitioner95018172CA

General Provider Information

NPI Number : 1861169252
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERVONNE LANEE JOHNSON
Provider Business Mailing Address
First Line : 30 PALATINE APT 338
Second Line :
City : IRVINE
State : CA
Zip : 92612-8864
Country : US
Telephone Number : 213-304-6050
Fax Number :
Provider Business Practice Location Address
First Line : 5901 W CENTURY BLVD STE 750
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5443
Country : US
Telephone Number : 888-880-3451
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2021
Last Update Date : 05/15/2024

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Directions to “ JERVONNE LANEE JOHNSON ” Practice Location

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