Provider Demographics
NPI:1760622468
Name:JOHNSON, CARLETTA ELAINE (RN)
Entity Type:Individual
Prefix:MISS
First Name:CARLETTA
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-3209
Mailing Address - Country:US
Mailing Address - Phone:740-624-2781
Mailing Address - Fax:
Practice Address - Street 1:1240 JACKSON ST
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3209
Practice Address - Country:US
Practice Address - Phone:740-624-2781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN346194163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse