Provider Demographics
NPI:1043406275
Name:JOHNSON, ALEDA MARIE (LVN)
Entity Type:Individual
Prefix:MS
First Name:ALEDA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23885 LAKE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2815
Mailing Address - Country:US
Mailing Address - Phone:951-640-8720
Mailing Address - Fax:
Practice Address - Street 1:23885 LAKE VISTA RD
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2815
Practice Address - Country:US
Practice Address - Phone:951-640-8720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN53019164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse