Provider Demographics
NPI:1760178768
Name:HERRON, JOHANA
Entity Type:Individual
Prefix:
First Name:JOHANA
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANA
Other - Middle Name:
Other - Last Name:TRANI MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:422 LYLE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1731
Mailing Address - Country:US
Mailing Address - Phone:937-789-8631
Mailing Address - Fax:
Practice Address - Street 1:422 LYLE DR
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1731
Practice Address - Country:US
Practice Address - Phone:937-789-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-05-26
Deactivation Date:2023-05-01
Deactivation Code:
Reactivation Date:2023-05-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide