Provider Demographics
NPI:1679380463
Name:WASHINGTON JOHNSON, LISA M (RN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:WASHINGTON JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:WASHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:939 WOODYCREST AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-5513
Mailing Address - Country:US
Mailing Address - Phone:347-468-0582
Mailing Address - Fax:
Practice Address - Street 1:939 WOODYCREST AVE APT 205
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5513
Practice Address - Country:US
Practice Address - Phone:347-468-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY487326163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator