Provider Demographics
NPI:1902797012
Name:JOHNSON, LIUDMILA
Entity type:Individual
Prefix:
First Name:LIUDMILA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12009 S 110TH AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5892
Mailing Address - Country:US
Mailing Address - Phone:402-669-6441
Mailing Address - Fax:
Practice Address - Street 1:12009 S 110TH AVENUE CIR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-5892
Practice Address - Country:US
Practice Address - Phone:402-669-6441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant