Provider Demographics
NPI:1811196835
Name:ABBOTT JOHNS, MARIE ELIZABETH (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ELIZABETH
Last Name:ABBOTT JOHNS
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 1:1782 W BURDICKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49664-9550
Mailing Address - Country:US
Mailing Address - Phone:231-218-0151
Mailing Address - Fax:
Practice Address - Street 1:1782 W BURDICKVILLE RD
Practice Address - Street 2:
Practice Address - City:MAPLE CITY
Practice Address - State:MI
Practice Address - Zip Code:49664-9550
Practice Address - Country:US
Practice Address - Phone:231-218-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703095454164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse