Provider Demographics
NPI:1790015733
Name:JOHNSON, CORBY SAMANTHA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CORBY
Middle Name:SAMANTHA
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 1:6939 TRENTON FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-1335
Mailing Address - Country:US
Mailing Address - Phone:513-217-1519
Mailing Address - Fax:
Practice Address - Street 1:6939 TRENTON FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-1335
Practice Address - Country:US
Practice Address - Phone:513-217-1519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse