Provider Demographics
NPI:1689452294
Name:JOHNSON, LAUREN (RNFA)
Entity Type:Individual
Prefix:MR
First Name:LAUREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 N COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-1013
Mailing Address - Country:US
Mailing Address - Phone:209-762-7787
Mailing Address - Fax:
Practice Address - Street 1:1328 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1013
Practice Address - Country:US
Practice Address - Phone:209-762-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693417163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant