Provider Demographics
NPI:1447696620
Name:JOHNSON, PRESCIOUS S (LPN)
Entity type:Individual
Prefix:MISS
First Name:PRESCIOUS
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CRESTLINE AVE
Mailing Address - Street 2:APT 222
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3082
Mailing Address - Country:US
Mailing Address - Phone:216-394-6150
Mailing Address - Fax:
Practice Address - Street 1:1400 CRESTLINE AVE
Practice Address - Street 2:APT 222
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109
Practice Address - Country:US
Practice Address - Phone:216-394-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.N152524164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse