Provider Demographics
NPI:1649969460
Name:JOHNSON, OLIVIA LEE (RN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 E BARSTOW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6039
Mailing Address - Country:US
Mailing Address - Phone:559-550-4344
Mailing Address - Fax:
Practice Address - Street 1:347 E BARSTOW AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6039
Practice Address - Country:US
Practice Address - Phone:559-550-4344
Practice Address - Fax:559-550-6011
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95224230163WM0102X
CA95027393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn