Provider Demographics
NPI:1295553824
Name:JOHNSON, DEKISHA LESHAWNA (CCMA)
Entity type:Individual
Prefix:
First Name:DEKISHA
Middle Name:LESHAWNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 LINDEN AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15902-2554
Mailing Address - Country:US
Mailing Address - Phone:215-678-9985
Mailing Address - Fax:
Practice Address - Street 1:313 LINDEN AVE APT 2
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15902-2554
Practice Address - Country:US
Practice Address - Phone:215-678-9985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty