Provider Demographics
NPI:1730522509
Name:JOHNSON, TOMMISINA VICTORIA (LPN)
Entity type:Individual
Prefix:
First Name:TOMMISINA
Middle Name:VICTORIA
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 1:461 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:15074-2019
Mailing Address - Country:US
Mailing Address - Phone:724-513-1314
Mailing Address - Fax:
Practice Address - Street 1:805 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-1505
Practice Address - Country:US
Practice Address - Phone:412-262-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN272494164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse