Provider Demographics
NPI:1669815601
Name:JOHNSON, FAYE E
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:E
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 1:7033 WOODY CT
Mailing Address - Street 2:
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-3059
Mailing Address - Country:US
Mailing Address - Phone:314-299-1402
Mailing Address - Fax:314-824-4488
Practice Address - Street 1:7033 WOODY CT
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3059
Practice Address - Country:US
Practice Address - Phone:314-299-1402
Practice Address - Fax:314-824-4488
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health