Provider Demographics
NPI:1780647503
Name:JOHNSON, DOROTHY L (RN)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
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 1:3855 MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-8816
Mailing Address - Country:US
Mailing Address - Phone:715-369-3784
Mailing Address - Fax:715-369-3784
Practice Address - Street 1:3855 MEADOW LN
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-8816
Practice Address - Country:US
Practice Address - Phone:715-369-3784
Practice Address - Fax:715-369-3784
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93176-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI382 38700Medicaid