Provider Demographics
NPI:1114261781
Name:JOHNSON, CHRISTINA DENISE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:DENISE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4616 IRA AVE.
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3820
Mailing Address - Country:US
Mailing Address - Phone:216-904-9949
Mailing Address - Fax:
Practice Address - Street 1:4616 IRA AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144-3820
Practice Address - Country:US
Practice Address - Phone:216-904-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.130163IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse