Provider Demographics
NPI:1447456850
Name:JOHNSON, JESSELYN (RN)
Entity type:Individual
Prefix:
First Name:JESSELYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13224 NEWPORT AVE
Mailing Address - Street 2:APT, 8A
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3401
Mailing Address - Country:US
Mailing Address - Phone:714-389-6851
Mailing Address - Fax:
Practice Address - Street 1:2001 E ORANGETHORPE AVE
Practice Address - Street 2:STE D
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6759
Practice Address - Country:US
Practice Address - Phone:714-525-5545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA672766163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory