Provider Demographics
NPI:1235995820
Name:JOHNSON, LATOYA E (LPN)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:E
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 1:23 CLOVER PARK DR APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-4526
Mailing Address - Country:US
Mailing Address - Phone:607-454-8538
Mailing Address - Fax:
Practice Address - Street 1:23 CLOVER PARK DR APT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4526
Practice Address - Country:US
Practice Address - Phone:607-454-8538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345780-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse