Basic Information
| Provider Information | |||||||||
| NPI: | 1114186525 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034356604 | ||||||||
| FaxNumber: | 7037876575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 TOWN CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034356604 | ||||||||
| FaxNumber: | 7037876575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 06/02/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WR0006X | 0001094221 | VA | Y | Nursing Service Providers | Registered Nurse | Registered Nurse First Assistant |
ID Information
| ID | Type | State | Issuer | Description | 0001094221 | 01 | VA | VIRGINIA LICENSE | OTHER |