Provider Demographics
NPI:1417442534
Name:DOSS, JOHNETTA
Entity Type:Individual
Prefix:
First Name:JOHNETTA
Middle Name:
Last Name:DOSS
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 1:3101 W NORWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63115-1063
Mailing Address - Country:US
Mailing Address - Phone:314-703-8263
Mailing Address - Fax:314-626-0828
Practice Address - Street 1:3101 W NORWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1063
Practice Address - Country:US
Practice Address - Phone:314-703-8263
Practice Address - Fax:314-626-0828
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health