Provider Demographics
NPI:1790025716
Name:JOHNSON, ELIZABETH HEGLER (RN)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:HEGLER
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 1:1245 BOOKMAN RD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8657
Mailing Address - Country:US
Mailing Address - Phone:803-699-1724
Mailing Address - Fax:803-699-0892
Practice Address - Street 1:1245 BOOKMAN RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8657
Practice Address - Country:US
Practice Address - Phone:803-699-1724
Practice Address - Fax:803-699-0892
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78514163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool