Provider Demographics
NPI:1316006299
Name:JOHNSON, HELEN VERNETTA (MD)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:VERNETTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 PARALLEL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-5702
Mailing Address - Country:US
Mailing Address - Phone:707-263-7428
Mailing Address - Fax:707-263-7425
Practice Address - Street 1:987 PARALLEL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5702
Practice Address - Country:US
Practice Address - Phone:707-263-7428
Practice Address - Fax:707-263-7425
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82139207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG82139OtherLICENSE
CA00G821390Medicaid
CA00G821390Medicaid
CA00G821390Medicare ID - Type UnspecifiedNHIC