Provider Demographics
NPI:1467158279
Name:JOHNSON, MERLON ELAINE
Entity Type:Individual
Prefix:
First Name:MERLON
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E AVENUE K6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4645
Mailing Address - Country:US
Mailing Address - Phone:661-471-4810
Mailing Address - Fax:661-524-2373
Practice Address - Street 1:335 E AVENUE K6
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4645
Practice Address - Country:US
Practice Address - Phone:661-471-4810
Practice Address - Fax:661-524-2373
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139403164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse