Provider Demographics
NPI:1912038332
Name:JOHNSON, MARVENE
Entity Type:Individual
Prefix:MS
First Name:MARVENE
Middle Name:
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:PO BOX 36408
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77236-6408
Mailing Address - Country:US
Mailing Address - Phone:713-541-6449
Mailing Address - Fax:713-270-7138
Practice Address - Street 1:6423 INDIGO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7202
Practice Address - Country:US
Practice Address - Phone:713-541-6449
Practice Address - Fax:713-270-7138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications