Provider Demographics
NPI:1073093571
Name:JOHNSON, RUTH NICOLE (RN)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:NICOLE
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 1:259 E FIRST ST
Mailing Address - Street 2:
Mailing Address - City:GROVETON
Mailing Address - State:TX
Mailing Address - Zip Code:75845-4838
Mailing Address - Country:US
Mailing Address - Phone:713-416-1946
Mailing Address - Fax:
Practice Address - Street 1:259 E FIRST ST
Practice Address - Street 2:
Practice Address - City:GROVETON
Practice Address - State:TX
Practice Address - Zip Code:75845-4838
Practice Address - Country:US
Practice Address - Phone:713-416-1946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX811788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse