Provider Demographics
NPI:1023560588
Name:JOHNSON, ALBERTA MARIE
Entity Type:Individual
Prefix:
First Name:ALBERTA
Middle Name:MARIE
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 1:6801 WILLIAM WALLACE WAY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5799
Mailing Address - Country:US
Mailing Address - Phone:512-568-4801
Mailing Address - Fax:512-291-3414
Practice Address - Street 1:6801 WILLIAM WALLACE WAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5799
Practice Address - Country:US
Practice Address - Phone:512-568-4801
Practice Address - Fax:512-291-3414
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-01
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0176893747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant