Provider Demographics
NPI:1710419296
Name:JOHNSON, LACRECIA SHANAI
Entity Type:Individual
Prefix:
First Name:LACRECIA
Middle Name:SHANAI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 10TH PLACE SE #T4
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON, D.C.
Mailing Address - State:DC
Mailing Address - Zip Code:20032-5957
Mailing Address - Country:US
Mailing Address - Phone:202-509-4670
Mailing Address - Fax:
Practice Address - Street 1:3323 10TH PLACE SE #T4
Practice Address - Street 2:
Practice Address - City:WASHINGTON, D.C.
Practice Address - State:DC
Practice Address - Zip Code:20032-5957
Practice Address - Country:US
Practice Address - Phone:202-509-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant