Provider Demographics
NPI:1922798024
Name:JOHNSON, MADISON VALLERY
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:VALLERY
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 1:9715 DANVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43106-9730
Mailing Address - Country:US
Mailing Address - Phone:740-505-7498
Mailing Address - Fax:
Practice Address - Street 1:9715 DANVILLE RD NE
Practice Address - Street 2:
Practice Address - City:BLOOMINGBURG
Practice Address - State:OH
Practice Address - Zip Code:43106-9730
Practice Address - Country:US
Practice Address - Phone:740-505-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant