Provider Demographics
NPI:1396197562
Name:JOHNSON, VICTORIA DANIELLE
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:DANIELLE
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 1:1126 SILVERWOOD DR
Mailing Address - Street 2:#215
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-7020
Mailing Address - Country:US
Mailing Address - Phone:682-308-0756
Mailing Address - Fax:
Practice Address - Street 1:1126 SILVERWOOD DR
Practice Address - Street 2:#215
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7020
Practice Address - Country:US
Practice Address - Phone:682-308-0756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX894270163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse