Provider Demographics
NPI:1871395723
Name:JOHNSON, DAWN RENEE (LPN)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:RENEE
Other - Last Name:STORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:3205 N TWYMAN RD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64058-3212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3205 N TWYMAN RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64058-3212
Practice Address - Country:US
Practice Address - Phone:816-825-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024934164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse