Provider Demographics
NPI:1750008983
Name:JOHNSON, HOLLI
Entity type:Individual
Prefix:
First Name:HOLLI
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 1:804 HARRIS STATION RD APT SUITE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:45612-9734
Mailing Address - Country:US
Mailing Address - Phone:740-542-9481
Mailing Address - Fax:740-542-9481
Practice Address - Street 1:11493 U.S. RT 50
Practice Address - Street 2:
Practice Address - City:BOURNEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45617-4561
Practice Address - Country:US
Practice Address - Phone:740-542-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH12345Medicaid