Provider Demographics
NPI:1467802850
Name:JOHNSON, MONETTA RUTH
Entity Type:Individual
Prefix:
First Name:MONETTA
Middle Name:RUTH
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 1:1103 BRIDLE DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-2512
Mailing Address - Country:US
Mailing Address - Phone:972-951-8393
Mailing Address - Fax:
Practice Address - Street 1:1103 BRIDLE DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-2512
Practice Address - Country:US
Practice Address - Phone:972-951-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other