Provider Demographics
NPI:1043037146
Name:JOHNSON, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17440 STATE ROUTE 775
Mailing Address - Street 2:
Mailing Address - City:WILLOW WOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45696-9053
Mailing Address - Country:US
Mailing Address - Phone:740-643-2879
Mailing Address - Fax:
Practice Address - Street 1:17440 STATE ROUTE 775
Practice Address - Street 2:
Practice Address - City:WILLOW WOOD
Practice Address - State:OH
Practice Address - Zip Code:45696-9053
Practice Address - Country:US
Practice Address - Phone:740-643-2879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant