Provider Demographics
NPI:1275266199
Name:JOHNSON, MELISSA SUE (RN,MSN,CCM)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN,MSN,CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 BLANCA DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-7414
Mailing Address - Country:US
Mailing Address - Phone:402-250-1749
Mailing Address - Fax:877-874-2463
Practice Address - Street 1:1433 BLANCA DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-7414
Practice Address - Country:US
Practice Address - Phone:402-250-1749
Practice Address - Fax:877-874-2463
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE63731163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE63731OtherSTATE OF NEBRASKA