Provider Demographics
NPI:1740601319
Name:JOHNSON, CRYSTAL RENEE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:RENEE
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:254 MOUNT PROSPECT AVE. APT. 405
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104
Mailing Address - Country:US
Mailing Address - Phone:252-676-2575
Mailing Address - Fax:
Practice Address - Street 1:85 BARTLETT STREET
Practice Address - Street 2:WHITE GLOVE COMMUNITY CARE, INC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-387-8181
Practice Address - Fax:718-782-1538
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278560164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse