Provider Demographics
NPI:1942068804
Name:JOHNSON, MONTAVIA TRANEE
Entity Type:Individual
Prefix:
First Name:MONTAVIA
Middle Name:TRANEE
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 1:3446 BOUDINOT AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-5710
Mailing Address - Country:US
Mailing Address - Phone:513-372-1293
Mailing Address - Fax:
Practice Address - Street 1:3446 BOUDINOT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-5710
Practice Address - Country:US
Practice Address - Phone:513-372-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602514780123376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide