Provider Demographics
NPI:1649692468
Name:JOHNSON, DONNA (RN)
Entity type:Individual
Prefix:MRS
First Name:DONNA
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 1:421 W FIVE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-9349
Mailing Address - Country:US
Mailing Address - Phone:803-442-6090
Mailing Address - Fax:803-442-6092
Practice Address - Street 1:421 W FIVE NOTCH RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-9349
Practice Address - Country:US
Practice Address - Phone:803-442-6090
Practice Address - Fax:803-442-6092
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN.108514R163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool