Individual
BROOK L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3402 STATE ROUTE 109 LOT 44, DELTA, OH 43515-9319
(419) 270-2905
Mailing address
3402 STATE ROUTE 109 LOT 44, DELTA, OH 43515-9319
(419) 270-2905
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
123788
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123788
OHIO BOARD OF NURSING
OH
Enumeration date
11/01/2012
Last updated
11/01/2012
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