Provider Demographics
NPI:1114182011
Name:JOHNSTON, CHERYL RENEE (AIDE)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 TIPPECANOE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2141
Mailing Address - Country:US
Mailing Address - Phone:330-808-3921
Mailing Address - Fax:
Practice Address - Street 1:917 TIPPECANOE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-2141
Practice Address - Country:US
Practice Address - Phone:330-808-3921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide