Provider Demographics
NPI:1679754907
Name:JOHNSON, PATRICIA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
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 1:30582 HORIZON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMP DOUGLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54618-8534
Mailing Address - Country:US
Mailing Address - Phone:608-769-0081
Mailing Address - Fax:
Practice Address - Street 1:30582 HORIZON AVE
Practice Address - Street 2:
Practice Address - City:CAMP DOUGLAS
Practice Address - State:WI
Practice Address - Zip Code:54618-8534
Practice Address - Country:US
Practice Address - Phone:608-769-0081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse