Basic Information
Provider Information
NPI: 1831362763
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: KAREN
MiddleName: LEE
NamePrefix: MRS.
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1010 ARCADIA RD
Address2:  
City: ENCINITAS
State: CA
PostalCode: 920244601
CountryCode: US
TelephoneNumber: 7606334281
FaxNumber:  
Practice Location
Address1: 550 W VISTA WAY
Address2:  
City: VISTA
State: CA
PostalCode: 920835732
CountryCode: US
TelephoneNumber: 7607249112
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/11/2008
LastUpdateDate: 04/11/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X505582CAY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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