Provider Demographics
NPI:1083230882
Name:JOHNSON, ALETHIA WANEDO
Entity Type:Individual
Prefix:
First Name:ALETHIA
Middle Name:WANEDO
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 1:3341 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1612
Mailing Address - Country:US
Mailing Address - Phone:313-740-3498
Mailing Address - Fax:
Practice Address - Street 1:3341 BLACKSTONE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1612
Practice Address - Country:US
Practice Address - Phone:313-740-3498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-18
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322201251110251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care