Provider Demographics
NPI:1528200821
Name:JOHNSON, COLLEEN M (LPN)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 W HIGHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-1635
Mailing Address - Country:US
Mailing Address - Phone:315-745-9304
Mailing Address - Fax:
Practice Address - Street 1:10201 W HIGHWOOD LN
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-1635
Practice Address - Country:US
Practice Address - Phone:315-745-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224847-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse