Individual
MRS. LEE ETTA JOHNIGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4698 HIGHWAY 145, MERIDIAN, MS 39301-8106
(601) 693-1677
Mailing address
4698 HIGHWAY 145, MERIDIAN, MS 39301-8106
(601) 693-1677
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PO74710
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00770207
PROVIDER NUMBER
MS
Enumeration date
04/23/2007
Last updated
07/08/2007
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