Provider Demographics
NPI:1790040715
Name:JOHNSON, CYNTHIA A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
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 1:227 WALRATH RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205-1833
Mailing Address - Country:US
Mailing Address - Phone:315-492-2234
Mailing Address - Fax:
Practice Address - Street 1:227 WALRATH RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13205-1833
Practice Address - Country:US
Practice Address - Phone:315-492-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302986-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse