Provider Demographics
NPI:1073233086
Name:JOHNSON, CHINA
Entity Type:Individual
Prefix:
First Name:CHINA
Middle Name:
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 1:20434 OLD HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MS
Mailing Address - Zip Code:39730-8548
Mailing Address - Country:US
Mailing Address - Phone:662-436-0275
Mailing Address - Fax:662-369-1727
Practice Address - Street 1:20434 OLD HOUSTON RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MS
Practice Address - Zip Code:39730-8548
Practice Address - Country:US
Practice Address - Phone:662-436-0275
Practice Address - Fax:662-369-1727
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS859219163W00000X, 163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163W00000XNursing Service ProvidersRegistered Nurse