MEDICARE: MRS. SKYLER JOHNSON LVN

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	293158	CA
2	164X00000X	Licensed Vocational Nurse	293158	CA

General Provider Information

NPI Number	:	1881156271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SKYLER JOHNSON LVN

Provider Business Mailing Address
First Line	:	3711 COMPASS POINTE AVE
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-9528
Country	:	US
Telephone Number	:	209-355-4173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 COMPASS POINTE AVE
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-9528
Country	:	US
Telephone Number	:	209-355-4173
Fax Number	:

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

Provider Enumeration Date	:	04/03/2019
Last Update Date	:	04/03/2019

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Directions to “ MRS. SKYLER JOHNSON LVN” Practice Location

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