Provider Demographics
NPI:1962836189
Name:JOHNSON, MARSHA A
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:A
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 1:8280 E DESTINY LN
Mailing Address - Street 2:
Mailing Address - City:SKIATOOK
Mailing Address - State:OK
Mailing Address - Zip Code:74070-5266
Mailing Address - Country:US
Mailing Address - Phone:918-698-4424
Mailing Address - Fax:
Practice Address - Street 1:8280 E DESTINY LN
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-5266
Practice Address - Country:US
Practice Address - Phone:918-698-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator