Provider Demographics
NPI:1487421608
Name:JOHNSON, LANETTE ELANE
Entity type:Individual
Prefix:
First Name:LANETTE
Middle Name:ELANE
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 1:4285 BROADWAY LOT C21
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-3072
Mailing Address - Country:US
Mailing Address - Phone:614-599-8603
Mailing Address - Fax:
Practice Address - Street 1:4285 BROADWAY LOT C21
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3072
Practice Address - Country:US
Practice Address - Phone:614-599-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide