Individual
MRS. LILLY ROSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 684-6671
Mailing address
101 LIGGETT AVE, FORT LEAVENWORTH, KS 66027-1228
(913) 364-4454
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0000062093
TN
Other
Enumeration date
11/18/2005
Last updated
07/08/2007
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