Provider Demographics
NPI:1215199344
Name:JOHNSON, CONSTANCE E (RN)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:CONSTANCE
Other - Middle Name:E
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:269 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-3227
Mailing Address - Country:US
Mailing Address - Phone:440-415-3077
Mailing Address - Fax:
Practice Address - Street 1:269 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-3227
Practice Address - Country:US
Practice Address - Phone:440-415-3077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH234320 OH163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2186530Medicaid
OH234340 OHOtherRN OH