Provider Demographics
NPI:1477090843
Name:JOHNSON, ANN MARIE (STNA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 VALERIE ARMS DR APT 311
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2124
Mailing Address - Country:US
Mailing Address - Phone:937-559-1517
Mailing Address - Fax:
Practice Address - Street 1:3341 VALERIE ARMS DR APT 311
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2124
Practice Address - Country:US
Practice Address - Phone:937-559-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide