Provider Demographics
NPI:1417623570
Name:JOHNSON-LONG, SANDRA (LPN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:JOHNSON-LONG
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 1:1097 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-9242
Mailing Address - Country:US
Mailing Address - Phone:802-748-6166
Mailing Address - Fax:802-748-3316
Practice Address - Street 1:1097 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-9242
Practice Address - Country:US
Practice Address - Phone:802-748-6466
Practice Address - Fax:802-748-3316
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0006204164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse