Provider Demographics
NPI:1255969705
Name:JOHNSON, NICOLE ROCHSHEL
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ROCHSHEL
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 1:840 BURMASTER ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053-2220
Mailing Address - Country:US
Mailing Address - Phone:504-322-7959
Mailing Address - Fax:
Practice Address - Street 1:4045 REGINA COELI CT
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-6354
Practice Address - Country:US
Practice Address - Phone:504-473-4295
Practice Address - Fax:504-264-7447
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
LA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide