Provider Demographics
NPI:1508443607
Name:JOHNSON, LANA LASHALL (LPN)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:LASHALL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:LANA
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:265 S OAK ST
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3128
Mailing Address - Country:US
Mailing Address - Phone:225-623-0912
Mailing Address - Fax:225-258-4025
Practice Address - Street 1:128 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5939
Practice Address - Country:US
Practice Address - Phone:985-651-3777
Practice Address - Fax:985-651-3770
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA941525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse