Provider Demographics
NPI:1063660876
Name:JOHNSON, TEWANNA RONIELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TEWANNA
Middle Name:RONIELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 NEWLODGE CT
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-5718
Mailing Address - Country:US
Mailing Address - Phone:615-837-0675
Mailing Address - Fax:615-837-0675
Practice Address - Street 1:1208 NEW LODGE CT
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:SD
Practice Address - Zip Code:37013-3618
Practice Address - Country:US
Practice Address - Phone:615-837-0675
Practice Address - Fax:615-837-0675
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000096892163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice