Provider Demographics
NPI:1477360121
Name:JOHNSON, BRIANNA NICOLE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
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 1:4166 STONEHAVEN RD
Mailing Address - Street 2:4166 STONEHAVEN RD.
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3163
Mailing Address - Country:US
Mailing Address - Phone:216-939-6141
Mailing Address - Fax:
Practice Address - Street 1:4166 STONEHAVEN RD
Practice Address - Street 2:4166 STONEHAVEN RD.
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3163
Practice Address - Country:US
Practice Address - Phone:216-939-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTY594887347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle