Provider Demographics
NPI:1467963637
Name:JOHNSON, TIFFANY DAWN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:DAWN
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2723 NE MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-0178
Mailing Address - Country:US
Mailing Address - Phone:503-449-7145
Mailing Address - Fax:
Practice Address - Street 1:9916 NE HIGHWAY 99
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-5608
Practice Address - Country:US
Practice Address - Phone:503-449-7145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201610057LPN164W00000X
WALP61315919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse