Provider Demographics
NPI:1518726330
Name:JOHNSON, DIAMONIQUE
Entity Type:Individual
Prefix:
First Name:DIAMONIQUE
Middle Name:
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 1:25401 BRIARDALE AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2255
Mailing Address - Country:US
Mailing Address - Phone:440-472-9240
Mailing Address - Fax:
Practice Address - Street 1:27381 SIDNEY DR APT 9
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2959
Practice Address - Country:US
Practice Address - Phone:216-376-0721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide