Provider Demographics
NPI:1437686912
Name:JOHNSON THOMAS, STARRY
Entity Type:Individual
Prefix:
First Name:STARRY
Middle Name:
Last Name:JOHNSON THOMAS
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 1:1752 PAISLEY ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44511-1023
Mailing Address - Country:US
Mailing Address - Phone:330-330-0434
Mailing Address - Fax:
Practice Address - Street 1:1752 PAISLEY ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-1023
Practice Address - Country:US
Practice Address - Phone:330-330-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0207996Medicaid