Provider Demographics
NPI:1669885091
Name:JOHNSON, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
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 1:10219 SALINEVILLE RD NE
Mailing Address - Street 2:
Mailing Address - City:SALINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43945-9461
Mailing Address - Country:US
Mailing Address - Phone:330-738-2206
Mailing Address - Fax:330-738-2206
Practice Address - Street 1:10219 SALINEVILLE RD NE
Practice Address - Street 2:
Practice Address - City:SALINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43945-9461
Practice Address - Country:US
Practice Address - Phone:330-738-2206
Practice Address - Fax:330-738-2206
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2806002Medicaid