Individual
MRS. STACIE LEE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
74 BERRY ST, WRENTHAM, MA 02093-1522
(774) 219-4588
Mailing address
74 BERRY ST PO BOX 45, WRENTHAM, MA 02093
(774) 219-4588
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LN86901
MA
Other
Enumeration date
04/16/2014
Last updated
04/16/2014
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