Provider Demographics
NPI:1962384636
Name:JOHNSON, JACQUELINE M (LPN)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
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 1:9404 N CHURCH DR APT 115
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4788
Mailing Address - Country:US
Mailing Address - Phone:216-466-3606
Mailing Address - Fax:
Practice Address - Street 1:9404 N CHURCH DR APT 115
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4788
Practice Address - Country:US
Practice Address - Phone:216-466-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189335164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse