Provider Demographics
NPI:1720112485
Name:JOHNSON, BILLIE JO
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:JO
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 1:2217 STATE ROUTE 763
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:OH
Mailing Address - Zip Code:45101-9348
Mailing Address - Country:US
Mailing Address - Phone:937-549-3997
Mailing Address - Fax:
Practice Address - Street 1:2217 STATE ROUTE 763
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:OH
Practice Address - Zip Code:45101-9348
Practice Address - Country:US
Practice Address - Phone:937-549-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2386154374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide