Provider Demographics
NPI:1235825373
Name:JOHNSON, TRANISHA DEANN
Entity Type:Individual
Prefix:
First Name:TRANISHA
Middle Name:DEANN
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 1:13101 PRESTON RD STE 110-5021
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-5237
Mailing Address - Country:US
Mailing Address - Phone:682-377-2547
Mailing Address - Fax:
Practice Address - Street 1:13101 PRESTON RD STE 110-5021
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-5237
Practice Address - Country:US
Practice Address - Phone:682-377-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy