Provider Demographics
NPI:1063656569
Name:JOHNSON, WILLIE JOYCE (NURSING ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:WILLIE
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSING ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15802 LESURE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3336
Mailing Address - Country:US
Mailing Address - Phone:877-526-3186
Mailing Address - Fax:
Practice Address - Street 1:15802 LESURE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227-3336
Practice Address - Country:US
Practice Address - Phone:877-526-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI230002612990406376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide