Provider Demographics
NPI:1134722580
Name:JOHNSON, JANICE E
Entity type:Individual
Prefix:PROF
First Name:JANICE
Middle Name:E
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 1:6155 82ND AVE NW
Mailing Address - Street 2:PO BOX 296
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0296
Mailing Address - Country:US
Mailing Address - Phone:760-473-4186
Mailing Address - Fax:
Practice Address - Street 1:6155 82ND AVE NW
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784
Practice Address - Country:US
Practice Address - Phone:760-473-4186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant