Provider Demographics
NPI:1972181956
Name:JOHNSON, JEANNE ANN (LPN)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANN
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 1:3420 MOSSWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-1648
Mailing Address - Country:US
Mailing Address - Phone:719-325-6671
Mailing Address - Fax:
Practice Address - Street 1:5360 N ACADEMY BLVD STE 290
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4038
Practice Address - Country:US
Practice Address - Phone:719-434-2061
Practice Address - Fax:719-434-2275
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0046062164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse