Provider Demographics
NPI:1710741616
Name:JOHNSON, RHONDA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:MARIE
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 1:22680 BUCHANAN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8014
Mailing Address - Country:US
Mailing Address - Phone:425-446-2128
Mailing Address - Fax:
Practice Address - Street 1:10530 19TH AVE SE STE A
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-4282
Practice Address - Country:US
Practice Address - Phone:425-357-1790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00057237164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse