Provider Demographics
NPI:1811885668
Name:JOHNSON, URSELIA ANTIONETTE
Entity type:Individual
Prefix:
First Name:URSELIA
Middle Name:ANTIONETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:URSELIA
Other - Middle Name:A
Other - Last Name:JOHNSON LE BLANC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3320 WALL BLVD APT 12-108
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-6614
Mailing Address - Country:US
Mailing Address - Phone:504-919-4899
Mailing Address - Fax:
Practice Address - Street 1:3320 WALL BLVD APT 12-108
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-6614
Practice Address - Country:US
Practice Address - Phone:504-919-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty