Provider Demographics
NPI:1053876417
Name:JOHNSON, BRANDI (LPN)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
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 1:497 BERLIN PLANK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2442
Mailing Address - Country:US
Mailing Address - Phone:814-289-1761
Mailing Address - Fax:
Practice Address - Street 1:645 RODI RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4564
Practice Address - Country:US
Practice Address - Phone:412-723-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-09
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN308903164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse