Provider Demographics
NPI:1821775594
Name:JOHNSON, DARA JANINE (LVN,PCD(DONA))
Entity Type:Individual
Prefix:
First Name:DARA
Middle Name:JANINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN,PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 MARIGOLD RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76708-6154
Mailing Address - Country:US
Mailing Address - Phone:254-548-8401
Mailing Address - Fax:
Practice Address - Street 1:10201 MARIGOLD RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76708-6154
Practice Address - Country:US
Practice Address - Phone:254-548-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14718374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula