Provider Demographics
NPI:1538289442
Name:JOHNSON, PAMELA FAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:FAY
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 1:44328 LAFFERTY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9791
Mailing Address - Country:US
Mailing Address - Phone:740-968-0068
Mailing Address - Fax:
Practice Address - Street 1:44328 LAFFERTY RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9791
Practice Address - Country:US
Practice Address - Phone:740-968-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN091552164W00000X
PAPN275454164W00000X
WV22696164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN091552OtherNURSING LICENSE
PAPN275454OtherPA NURSING LICENSE
OH2189224OtherIP NUMBER
WV22696OtherWV NURSING LICENSE