Provider Demographics
NPI:1952835993
Name:JOHNSON, CHRISTINA KATHLEEN (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KATHLEEN
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 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-661-1590
Mailing Address - Fax:716-661-1495
Practice Address - Street 1:880 E 2ND ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-3824
Practice Address - Country:US
Practice Address - Phone:716-661-1590
Practice Address - Fax:716-661-1495
Is Sole Proprietor?:No
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY320262164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY320262OtherSTATE LICENSE NUMBER