Provider Demographics
NPI:1790808442
Name:JOHNSON, VIRGINIA ANN
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ANN
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 1:1310 DUGAN RD
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-9669
Mailing Address - Country:US
Mailing Address - Phone:740-423-0501
Mailing Address - Fax:740-423-0501
Practice Address - Street 1:1310 DUGAN RD
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-9669
Practice Address - Country:US
Practice Address - Phone:740-423-0501
Practice Address - Fax:740-423-0501
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2681432Medicaid