Provider Demographics
NPI:1053064758
Name:JOHNSON, PATRICIA EVON
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:EVON
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 1:3233 LILLIAN PL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-4602
Mailing Address - Country:US
Mailing Address - Phone:910-580-6627
Mailing Address - Fax:910-433-1588
Practice Address - Street 1:3233 LILLIAN PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-4602
Practice Address - Country:US
Practice Address - Phone:910-580-6627
Practice Address - Fax:910-433-1588
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant