Provider Demographics
NPI:1578126090
Name:JOHNSON, MONICA DAVIS (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:DAVIS
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:PO BOX 964
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36461-0964
Mailing Address - Country:US
Mailing Address - Phone:251-575-4203
Mailing Address - Fax:251-575-9459
Practice Address - Street 1:220 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3156
Practice Address - Country:US
Practice Address - Phone:251-578-4545
Practice Address - Fax:251-578-4583
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-050855164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse