Provider Demographics
NPI:1235800681
Name:JOHNSON, HEATHER CHRISTINE (LVN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:591 HILLTOP DR APT 46
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4838
Mailing Address - Country:US
Mailing Address - Phone:707-616-0190
Mailing Address - Fax:
Practice Address - Street 1:591 HILLTOP DR APT 46
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4838
Practice Address - Country:US
Practice Address - Phone:707-616-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704545164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA704545OtherCALIFORNIA BOARD OF NURSING