Provider Demographics
NPI:1649872359
Name:JOHNSON, LINDA ANN (CNA, LPN-A)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA, LPN-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:23075-1310
Mailing Address - Country:US
Mailing Address - Phone:804-855-4262
Mailing Address - Fax:
Practice Address - Street 1:103 S CEDAR AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:23075-1310
Practice Address - Country:US
Practice Address - Phone:804-855-4262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401063588376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG20713087OtherHENRICO, VA BUSINESS SECTION INTERNAL NO