Provider Demographics
NPI:1295979581
Name:JOHNSON, DONNA RAE (LPN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:RAE
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 1:8932 N 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7710
Mailing Address - Country:US
Mailing Address - Phone:623-876-7944
Mailing Address - Fax:623-523-8811
Practice Address - Street 1:15550 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7465
Practice Address - Country:US
Practice Address - Phone:623-876-7944
Practice Address - Fax:623-523-8811
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP009341164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse