Provider Demographics
NPI:1528571213
Name:JOHNSON, RENEE D (CNMT, RT(N)(ARRT))
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNMT, RT(N)(ARRT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-5489
Mailing Address - Country:US
Mailing Address - Phone:510-417-5711
Mailing Address - Fax:510-964-4644
Practice Address - Street 1:1363 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-5489
Practice Address - Country:US
Practice Address - Phone:510-417-5711
Practice Address - Fax:510-964-4947
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHN00004087374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician