Provider Demographics
NPI:1689935215
Name:JOHNSON, ASHLEY DIANE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:DIANE
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 1:3068 COUNTY ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-3404
Mailing Address - Country:US
Mailing Address - Phone:518-932-5983
Mailing Address - Fax:
Practice Address - Street 1:3068 COUNTY ROUTE 46
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-3404
Practice Address - Country:US
Practice Address - Phone:518-932-5983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280591-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse