Provider Demographics
NPI:1225652928
Name:JOHNSON, CHARLA (DNP, RN, ONC)
Entity Type:Individual
Prefix:
First Name:CHARLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, RN, ONC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9346 S HODGESON RD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-8429
Mailing Address - Country:US
Mailing Address - Phone:225-276-8789
Mailing Address - Fax:
Practice Address - Street 1:9346 S HODGESON RD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-8429
Practice Address - Country:US
Practice Address - Phone:225-276-8789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN060055163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic