Basic Information
| Provider Information | |||||||||
| NPI: | 1417623570 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON-LONG | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1097 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058199242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027486166 | ||||||||
| FaxNumber: | 8027483316 | ||||||||
| Practice Location | |||||||||
| Address1: | 1097 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT JOHNSBURY | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058199242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027486466 | ||||||||
| FaxNumber: | 8027483316 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2021 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 025.0006204 | VT | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.