Provider Demographics
NPI:1013587773
Name:JOHNSON, JOANN RENA
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:RENA
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 1:10757 SPRING GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-4534
Mailing Address - Country:US
Mailing Address - Phone:314-396-0043
Mailing Address - Fax:
Practice Address - Street 1:9021 RIVERVIEW DR STE 310
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63137-2424
Practice Address - Country:US
Practice Address - Phone:314-396-0043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker