Provider Demographics
NPI:1689048928
Name:JOHNSON, LEONA SARAH (LPN)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:SARAH
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 248
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13493-0248
Mailing Address - Country:US
Mailing Address - Phone:315-558-4206
Mailing Address - Fax:
Practice Address - Street 1:2231 COUNTY ROUTE 12
Practice Address - Street 2:APARTMENT 101
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-4500
Practice Address - Country:US
Practice Address - Phone:315-668-8966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228614-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse