Provider Demographics
NPI:1114354743
Name:JOHNSON, CHANAYA R (RN)
Entity Type:Individual
Prefix:MS
First Name:CHANAYA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CHANAYA
Other - Middle Name:ROXANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1801 N TRYON ST
Mailing Address - Street 2:SUITE 305-B
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28206-2704
Mailing Address - Country:US
Mailing Address - Phone:704-948-5654
Mailing Address - Fax:704-948-5658
Practice Address - Street 1:1801 N TRYON ST
Practice Address - Street 2:SUITE 305-B
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28206-2704
Practice Address - Country:US
Practice Address - Phone:704-948-5654
Practice Address - Fax:704-948-5658
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1445163W00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No376K00000XNursing Service Related ProvidersNurse's Aide