Provider Demographics
NPI:1548617087
Name:JOHNSON, STEVEN WAYNE (LPN)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:WAYNE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 41ST STREET RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-2429
Mailing Address - Country:US
Mailing Address - Phone:970-518-8888
Mailing Address - Fax:
Practice Address - Street 1:1140 M ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-9586
Practice Address - Country:US
Practice Address - Phone:970-347-2293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-14
Last Update Date:2016-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0047484164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse