Provider Demographics
NPI:1720705791
Name:JOHNSON, ANGEL LATASHA
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:LATASHA
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 1:5476 LONSDALE PL N APT C
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-8013
Mailing Address - Country:US
Mailing Address - Phone:614-906-8420
Mailing Address - Fax:
Practice Address - Street 1:5476 LONSDALE PL N APT C
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-8013
Practice Address - Country:US
Practice Address - Phone:614-906-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide