Provider Demographics
NPI:1164608899
Name:JOHNSON, DEBORAH ELIZABETH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:ELIZABETH
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 1:2100 WHITEHALL ST
Mailing Address - Street 2:APT 53
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-2292
Mailing Address - Country:US
Mailing Address - Phone:518-273-4391
Mailing Address - Fax:
Practice Address - Street 1:2100 WHITEHALL ST
Practice Address - Street 2:APT 53
Practice Address - City:WATERVLIET
Practice Address - State:NY
Practice Address - Zip Code:12189-2292
Practice Address - Country:US
Practice Address - Phone:518-273-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY283780164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse