Provider Demographics
NPI:1346477692
Name:JOHNSON, LEVONDA ANTOINETTE (RCIS, ASA)
Entity Type:Individual
Prefix:MS
First Name:LEVONDA
Middle Name:ANTOINETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RCIS, ASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 HOMINY RDG
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-7428
Mailing Address - Country:US
Mailing Address - Phone:972-333-1705
Mailing Address - Fax:
Practice Address - Street 1:6830 HOMINY RDG
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-7428
Practice Address - Country:US
Practice Address - Phone:972-333-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00024258246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist