Provider Demographics
NPI:1518103241
Name:JOHNSON, PATRICIA POTTER (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:POTTER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:POTTER
Other - Last Name:FRANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:413 VIRGO WAY
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-9011
Mailing Address - Country:US
Mailing Address - Phone:970-858-7725
Mailing Address - Fax:
Practice Address - Street 1:2121 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6428
Practice Address - Country:US
Practice Address - Phone:970-242-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO32320164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse