Basic Information
| Provider Information | |||||||||
| NPI: | 1417319047 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1130 RED OAK LN | ||||||||
| Address2: | |||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549151107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207334443 | ||||||||
| FaxNumber: | 9207334796 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 N BALLARD RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | APPLETON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 549118928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9207334443 | ||||||||
| FaxNumber: | 9207334796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2016 | ||||||||
| LastUpdateDate: | 03/23/2016 | ||||||||
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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 | 164W00000X | 316224 | WI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.