Provider Demographics
NPI:1336900943
Name:JOHNSON, ROSHANDER
Entity Type:Individual
Prefix:
First Name:ROSHANDER
Middle Name:
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 1:3210 NANDALE DR APT 7
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4162
Mailing Address - Country:US
Mailing Address - Phone:513-602-4957
Mailing Address - Fax:
Practice Address - Street 1:3210 NANDALE DR APT 7
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4162
Practice Address - Country:US
Practice Address - Phone:513-602-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376K00000XNursing Service Related ProvidersNurse's Aide