Provider Demographics
NPI:1710695697
Name:JOHNSON, HELEN KATHLEEN
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:KATHLEEN
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 1:318 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3066
Mailing Address - Country:US
Mailing Address - Phone:541-672-1440
Mailing Address - Fax:
Practice Address - Street 1:318 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3066
Practice Address - Country:US
Practice Address - Phone:541-672-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty