Provider Demographics
NPI:1053100586
Name:JOHNSON, TEONGELA
Entity type:Individual
Prefix:
First Name:TEONGELA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18123 MCCRACKEN RD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1519
Mailing Address - Country:US
Mailing Address - Phone:216-315-8189
Mailing Address - Fax:
Practice Address - Street 1:18123 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1519
Practice Address - Country:US
Practice Address - Phone:216-315-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No342000000XTransportation ServicesTransportation Network Company