Individual
LEA JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1417 SWAMP FOX LN, CHARLESTON, SC 29412-5320
(410) 596-4825
Mailing address
1417 SWAMP FOX LN, CHARLESTON, SC 29412-5320
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R209318
MD
Other
Enumeration date
05/06/2020
Last updated
05/06/2020
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