Provider Demographics
NPI:1639643745
Name:JOHNSON, GLORIA ANN
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ANN
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 1:21750 NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-3064
Mailing Address - Country:US
Mailing Address - Phone:440-452-7598
Mailing Address - Fax:
Practice Address - Street 1:21750 NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-3064
Practice Address - Country:US
Practice Address - Phone:440-452-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide