Provider Demographics
NPI:1639896442
Name:JOHNSON, NORMA JEAN
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:JEAN
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 1:3917 LILLIE ST
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-3889
Mailing Address - Country:US
Mailing Address - Phone:469-407-1071
Mailing Address - Fax:469-304-1904
Practice Address - Street 1:3917 LILLIE ST
Practice Address - Street 2:
Practice Address - City:SACHSE
Practice Address - State:TX
Practice Address - Zip Code:75048-3889
Practice Address - Country:US
Practice Address - Phone:469-407-1071
Practice Address - Fax:469-304-1904
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No253Z00000XAgenciesIn Home Supportive Care