Provider Demographics
NPI:1689375750
Name:JOHNSON, INDIANA STARR
Entity Type:Individual
Prefix:
First Name:INDIANA
Middle Name:STARR
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 1:10 COLEMAN HL
Mailing Address - Street 2:
Mailing Address - City:WEST HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25571-8021
Mailing Address - Country:US
Mailing Address - Phone:304-824-2326
Mailing Address - Fax:
Practice Address - Street 1:10 COLEMAN HL
Practice Address - Street 2:
Practice Address - City:WEST HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25571-8021
Practice Address - Country:US
Practice Address - Phone:304-824-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant