Provider Demographics
NPI:1134827579
Name:JOHNSON, DANA S (RMA/CAREGIVER)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RMA/CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HANOVER AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-6210
Mailing Address - Country:US
Mailing Address - Phone:540-681-3114
Mailing Address - Fax:
Practice Address - Street 1:2220 HANOVER AVE NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-6210
Practice Address - Country:US
Practice Address - Phone:540-681-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA132957251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health