Provider Demographics
NPI:1699566448
Name:JOHNSON, BRANDEN EMANUEL (MEDICATION AIDE 40HR)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:EMANUEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MEDICATION AIDE 40HR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 W SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-1640
Mailing Address - Country:US
Mailing Address - Phone:531-220-1919
Mailing Address - Fax:531-220-1919
Practice Address - Street 1:829 W SUMNER ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-1640
Practice Address - Country:US
Practice Address - Phone:531-220-1919
Practice Address - Fax:531-220-1919
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26362305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization