Provider Demographics
NPI:1740538867
Name:PETA, LANA JOHNSON (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:JOHNSON
Last Name:PETA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 WELLESLEY ST
Mailing Address - Street 2:ATTN: HEALTH SERVICES
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1545
Mailing Address - Country:US
Mailing Address - Phone:781-768-7290
Mailing Address - Fax:781-768-7288
Practice Address - Street 1:235 WELLESLEY ST
Practice Address - Street 2:ATTN: HEALTH SERVICES
Practice Address - City:WESTON
Practice Address - State:MA
Practice Address - Zip Code:02493-1545
Practice Address - Country:US
Practice Address - Phone:781-768-7290
Practice Address - Fax:781-768-7288
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN225742363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily