Individual provider Active NPI

Andre'a Johnson, LPN

  • Licensed Practical Nurse
  • Maumee, OH
National Provider Identifier
1932665494
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Licensed Practical NurseTaxonomy code 164W00000X
License
LPN.171044.MEDS-IV Issued in OH
Practice address
1655 Holland Rd Ste F
Maumee, OH 43537-1656
Phone
(513) 834-7063
NPI assigned
Feb 20, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Licensed Practical Nurse 164W00000X LPN.171044.MEDS-IV OH Primary

Addresses

Primary practice location

1655 Holland Rd Ste F
Maumee, OH 43537-1656

Mailing address

615 Elsinore PL Ste 200
Cincinnati, OH 45202-1457
Phone (513) 834-7063

Other practice location 1

27777 Inkster Rd Ste 100
Farmington Hills, MI 48334-5326
Phone (248) 436-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LPN.171044.MEDS-IVOHMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1932665494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 ELSINORE PL STE 200",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452021457",
            "telephone_number": "513-834-7063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1655 HOLLAND RD STE F",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371656",
            "telephone_number": "513-834-7063"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27777 Inkster Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Farmington Hills",
            "state": "MI",
            "postal_code": "483345326",
            "country_code": "US",
            "telephone_number": "248-436-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANDRE'A",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-20",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "OH",
            "license": "LPN.171044.MEDS-IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maumee, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.