Provider Demographics
NPI:1174033450
Name:JOHNSON-NIMLEY, LULA M
Entity Type:Individual
Prefix:
First Name:LULA
Middle Name:M
Last Name:JOHNSON-NIMLEY
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 1:1590 TAIT RD SW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-9644
Mailing Address - Country:US
Mailing Address - Phone:330-727-1858
Mailing Address - Fax:
Practice Address - Street 1:1590 TAIT RD SW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-9644
Practice Address - Country:US
Practice Address - Phone:330-727-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide