Provider Demographics
NPI:1457626236
Name:JOHNSOM, COMFORT
Entity Type:Individual
Prefix:MRS
First Name:COMFORT
Middle Name:
Last Name:JOHNSOM
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 1:4200 RED MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1145
Mailing Address - Country:US
Mailing Address - Phone:240-694-7024
Mailing Address - Fax:
Practice Address - Street 1:4200 RED MAPLE CT
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1145
Practice Address - Country:US
Practice Address - Phone:240-694-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1201002251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care