Provider Demographics
NPI:1356578660
Name:JOHNSON, DEMINEA L
Entity type:Individual
Prefix:
First Name:DEMINEA
Middle Name:L
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 1:7825 MANDAN RD
Mailing Address - Street 2:#303
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2145
Mailing Address - Country:US
Mailing Address - Phone:301-313-9050
Mailing Address - Fax:
Practice Address - Street 1:7825 MANDAN RD
Practice Address - Street 2:#303
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2145
Practice Address - Country:US
Practice Address - Phone:301-313-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN962900163W00000X
MDR158488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse