Provider Demographics
NPI:1023220084
Name:JOHNSON, TERESA ANN (NAHHA)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NAHHA
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NAHHA
Mailing Address - Street 1:1310 DUGAN RD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-9669
Mailing Address - Country:US
Mailing Address - Phone:740-423-0501
Mailing Address - Fax:
Practice Address - Street 1:1310 DUGAN RD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-9669
Practice Address - Country:US
Practice Address - Phone:740-423-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484744Medicaid