Provider Demographics
NPI:1679124929
Name:BROPHY, JOHNNIE LYNN (RN)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:LYNN
Last Name:BROPHY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-3637
Mailing Address - Country:US
Mailing Address - Phone:541-980-0168
Mailing Address - Fax:
Practice Address - Street 1:2121 W 14TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3637
Practice Address - Country:US
Practice Address - Phone:541-980-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083044815163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse