Provider Demographics
NPI:1356501746
Name:JOHNSON, JANICE B (LPN)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:B
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 1:2035 WOODDALE BLVD
Mailing Address - Street 2:D
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-1517
Mailing Address - Country:US
Mailing Address - Phone:225-926-5300
Mailing Address - Fax:225-926-5566
Practice Address - Street 1:2035 WOODDALE BLVD
Practice Address - Street 2:D
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-1517
Practice Address - Country:US
Practice Address - Phone:225-926-5300
Practice Address - Fax:225-926-5566
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1585705Medicaid