Provider Demographics
NPI:1457315046
Name:JOHNSON, CINDY L (LPN RCS)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-5128
Mailing Address - Country:US
Mailing Address - Phone:608-365-0392
Mailing Address - Fax:
Practice Address - Street 1:1041 8TH ST
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-5128
Practice Address - Country:US
Practice Address - Phone:608-365-0392
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse