Provider Demographics
NPI:1881296242
Name:JOHNSON, DANIEL (LPN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 W COKEDALE DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1707
Mailing Address - Country:US
Mailing Address - Phone:719-214-9447
Mailing Address - Fax:
Practice Address - Street 1:275 W ABRIENDO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1870
Practice Address - Country:US
Practice Address - Phone:720-987-7242
Practice Address - Fax:719-621-4974
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPN.0336297164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPN.0336297OtherLPN LICENSE