Provider Demographics
NPI:1801435235
Name:JOHNSON, DEAN MICHEAL (RN)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:MICHEAL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7538 MID TOWN RD APT 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3454
Mailing Address - Country:US
Mailing Address - Phone:608-482-2276
Mailing Address - Fax:
Practice Address - Street 1:7538 MID TOWN RD APT 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-3454
Practice Address - Country:US
Practice Address - Phone:608-482-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI238416163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse