Provider Demographics
NPI:1205535093
Name:JOHNSON, LETITIA MICHELLE (LPN)
Entity type:Individual
Prefix:MS
First Name:LETITIA
Middle Name:MICHELLE
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 1:3088 CRANBERRY HWY STE A
Mailing Address - Street 2:
Mailing Address - City:EAST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02538-4800
Mailing Address - Country:US
Mailing Address - Phone:508-295-7990
Mailing Address - Fax:508-295-3781
Practice Address - Street 1:3088 CRANBERRY HWY STE A
Practice Address - Street 2:
Practice Address - City:EAST WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02538-4800
Practice Address - Country:US
Practice Address - Phone:508-295-7990
Practice Address - Fax:508-295-3781
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN96749164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse