Provider Demographics
NPI:1407445695
Name:JOHNSON, NORA
Entity Type:Individual
Prefix:
First Name:NORA
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 1:57 PLUM LANE
Mailing Address - Street 2:
Mailing Address - City:SETH
Mailing Address - State:WV
Mailing Address - Zip Code:25181
Mailing Address - Country:US
Mailing Address - Phone:304-837-3829
Mailing Address - Fax:
Practice Address - Street 1:57 PLUM LANE
Practice Address - Street 2:
Practice Address - City:SETH
Practice Address - State:WV
Practice Address - Zip Code:25181
Practice Address - Country:US
Practice Address - Phone:304-837-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care