Provider Demographics
NPI:1841798972
Name:JOHNSON, NATISHA TAMEL (LPN)
Entity Type:Individual
Prefix:
First Name:NATISHA
Middle Name:TAMEL
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 1:448 RIGLAW CIR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7825
Mailing Address - Country:US
Mailing Address - Phone:803-238-1900
Mailing Address - Fax:
Practice Address - Street 1:448 RIGLAW CIR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29073-7825
Practice Address - Country:US
Practice Address - Phone:803-238-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP40470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4101977OtherBIRTHDAY