Provider Demographics
NPI:1013312420
Name:JOHNS, LORE (LPN)
Entity Type:Individual
Prefix:
First Name:LORE
Middle Name:
Last Name: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 1:209 CENTRAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:FL
Mailing Address - Zip Code:32052-6153
Mailing Address - Country:US
Mailing Address - Phone:386-792-1414
Mailing Address - Fax:
Practice Address - Street 1:5683 US HIGHWAY 129 S
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:FL
Practice Address - Zip Code:32052-6793
Practice Address - Country:US
Practice Address - Phone:386-792-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5206079164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse