Provider Demographics
NPI:1831678317
Name:JOHNSON, PATRICIA NORMA (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:NORMA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3860 THOROUGHBRED TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2570
Mailing Address - Country:US
Mailing Address - Phone:817-908-4072
Mailing Address - Fax:
Practice Address - Street 1:3860 THOROUGHBRED TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-2570
Practice Address - Country:US
Practice Address - Phone:817-908-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-07
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX509878163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse