Provider Demographics
NPI:1528386869
Name:JOHNSON, PATRICIA JOYCE
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:JOYCE
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5532 W LEON TER
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1228
Mailing Address - Country:US
Mailing Address - Phone:414-839-0701
Mailing Address - Fax:
Practice Address - Street 1:5532 W LEON TER
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-1228
Practice Address - Country:US
Practice Address - Phone:414-839-0701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31976031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse