Provider Demographics
NPI:1720528003
Name:JOHNSON, RASHELLE M (LPTA)
Entity Type:Individual
Prefix:
First Name:RASHELLE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:RASHELLE
Other - Middle Name:M
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:2457 NE BOBBI PL
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-9089
Mailing Address - Country:US
Mailing Address - Phone:541-480-7040
Mailing Address - Fax:
Practice Address - Street 1:2457 NE BOBBI PL
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-9089
Practice Address - Country:US
Practice Address - Phone:541-480-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR07463314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility