Provider Demographics
NPI:1336373315
Name:LINDA J JOHNSON
Entity Type:Organization
Organization Name:LINDA J JOHNSON
Other - Org Name:LINDA J JOHNSON
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:J JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:419-243-4274
Mailing Address - Street 1:3611 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1240
Mailing Address - Country:US
Mailing Address - Phone:419-243-4274
Mailing Address - Fax:
Practice Address - Street 1:3611 ELM ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1240
Practice Address - Country:US
Practice Address - Phone:419-243-4274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118049302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization