Provider Demographics
NPI:1487213765
Name:JOHNSON, INGA RENEE (LPN)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:INGA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1575 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-6859
Mailing Address - Country:US
Mailing Address - Phone:225-221-3397
Mailing Address - Fax:
Practice Address - Street 1:1575 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-6859
Practice Address - Country:US
Practice Address - Phone:225-221-3397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200285164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse