Provider Demographics
NPI:1619216116
Name:JOHNSON, SVITLANA (R N)
Entity Type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5680 HADLEY AVE N
Mailing Address - Street 2:APT 121
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-1004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2586 7TH AVE E
Practice Address - Street 2:SUITE 302
Practice Address - City:NORTH ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55109-3083
Practice Address - Country:US
Practice Address - Phone:651-789-8775
Practice Address - Fax:651-789-8795
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-203288-5163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health