Provider Demographics
NPI:1255686242
Name:JOHNSON, CIARA MONIQUE (RN)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:MONIQUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26151 LAKESHORE BLVD
Mailing Address - Street 2:1921
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-848-7080
Mailing Address - Fax:
Practice Address - Street 1:26151 LAKE SHORE BLVD
Practice Address - Street 2:1921
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1176
Practice Address - Country:US
Practice Address - Phone:216-848-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376356163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2855398Medicaid