Provider Demographics
NPI:1043458649
Name:JOHNSON, ANGELA FELICIA (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:FELICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2222
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-0322
Mailing Address - Country:US
Mailing Address - Phone:845-483-1175
Mailing Address - Fax:
Practice Address - Street 1:77 CARROLL ST APT 3
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-4523
Practice Address - Country:US
Practice Address - Phone:845-430-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10270493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse