Provider Demographics
NPI:1124535232
Name:JOHNSON, HERLYNDA
Entity Type:Individual
Prefix:
First Name:HERLYNDA
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 1:2260 PAR LN APT 819
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-2950
Mailing Address - Country:US
Mailing Address - Phone:216-253-6645
Mailing Address - Fax:
Practice Address - Street 1:2260 PAR LN APT 819
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY HILLS
Practice Address - State:OH
Practice Address - Zip Code:44094-2950
Practice Address - Country:US
Practice Address - Phone:216-253-6645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker