Provider Demographics
NPI:1073900585
Name:JOHNSON, DAWN (LPN)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:A
Other - Last Name:BRIZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 174
Mailing Address - Street 2:101 LILAC PARK DRIVE
Mailing Address - City:MANNSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13661
Mailing Address - Country:US
Mailing Address - Phone:315-771-7496
Mailing Address - Fax:
Practice Address - Street 1:101 LILAC PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MANNSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13661
Practice Address - Country:US
Practice Address - Phone:315-771-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258132164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse