Provider Demographics
NPI:1215193032
Name:JOHNSON, LAKISHA ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:LAKISHA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 W MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3435
Mailing Address - Country:US
Mailing Address - Phone:631-422-2300
Mailing Address - Fax:631-422-3398
Practice Address - Street 1:181 W MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3435
Practice Address - Country:US
Practice Address - Phone:631-422-2300
Practice Address - Fax:631-422-3398
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY548745-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health