Provider Demographics
NPI:1396179826
Name:ALTMAN, JOHANNA (RN)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29555-6517
Mailing Address - Country:US
Mailing Address - Phone:843-386-2955
Mailing Address - Fax:
Practice Address - Street 1:160 E MARION ST
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29555-6517
Practice Address - Country:US
Practice Address - Phone:843-386-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN.72952163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool