Provider Demographics
NPI:1831651025
Name:ODEA JOHNSON, MEAGHAN MARGARET (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:MARGARET
Last Name:ODEA JOHNSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21515 HAWTHORNE BLVD # GL-100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-6501
Mailing Address - Country:US
Mailing Address - Phone:424-571-2618
Mailing Address - Fax:
Practice Address - Street 1:21515 HAWTHORNE BLVD # GL-100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-6501
Practice Address - Country:US
Practice Address - Phone:424-571-2618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2306922363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics