Provider Demographics
NPI:1073142584
Name:JOHNSON, CAMERON R I
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:R
Last Name:JOHNSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2581 CASCADE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3771
Mailing Address - Country:US
Mailing Address - Phone:517-416-8547
Mailing Address - Fax:
Practice Address - Street 1:2581 CASCADE CREEK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3771
Practice Address - Country:US
Practice Address - Phone:517-416-8547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty