Provider Demographics
NPI:1629102348
Name:JOHNSON, GINIA LOU
Entity Type:Individual
Prefix:
First Name:GINIA
Middle Name:LOU
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 1:8099 ASHRIDGE ARNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:SARDINIA
Mailing Address - State:OH
Mailing Address - Zip Code:45171-9168
Mailing Address - Country:US
Mailing Address - Phone:937-515-3826
Mailing Address - Fax:
Practice Address - Street 1:8099 ASHRIDGE ARNHEIM RD
Practice Address - Street 2:
Practice Address - City:SARDINIA
Practice Address - State:OH
Practice Address - Zip Code:45171-9168
Practice Address - Country:US
Practice Address - Phone:937-515-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2520481374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide