Provider Demographics
NPI:1639236615
Name:JOHNSON, MEL JOSEPH (RN)
Entity Type:Individual
Prefix:MR
First Name:MEL
Middle Name:JOSEPH
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E LASSEN AVE SPC 56
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0547
Mailing Address - Country:US
Mailing Address - Phone:530-343-9068
Mailing Address - Fax:
Practice Address - Street 1:370 E LASSEN AVE SPC 56
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0547
Practice Address - Country:US
Practice Address - Phone:530-343-9068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457078163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN457078OtherRN LICENSE NUMBER