Provider Demographics
NPI:1679159834
Name:JOHNSON, LORI EILEEN (CRNP)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:EILEEN
Last Name:JOHNSON
Suffix:
Gender:
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WYNTRE BROOKE DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-4535
Mailing Address - Country:US
Mailing Address - Phone:717-849-5589
Mailing Address - Fax:717-472-8278
Practice Address - Street 1:80 WYNTRE BROOKE DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4535
Practice Address - Country:US
Practice Address - Phone:717-849-5589
Practice Address - Fax:717-472-8278
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027041363LA2200X, 363LP2300X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164409561Medicaid