Provider Demographics
NPI:1679295943
Name:DEAN, JOHNNA (LPN)
Entity type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:DEAN
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 1:298 TRICORN RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25053-7148
Mailing Address - Country:US
Mailing Address - Phone:304-369-1385
Mailing Address - Fax:304-369-9684
Practice Address - Street 1:298 TRICORN RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7148
Practice Address - Country:US
Practice Address - Phone:304-369-1385
Practice Address - Fax:304-369-9684
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV21160OtherLPN LICENSE