Provider Demographics
NPI:1770897514
Name:JOHNSON, MARCIA (NP)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 RUWES OAK DR.
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248
Mailing Address - Country:US
Mailing Address - Phone:513-574-2224
Mailing Address - Fax:
Practice Address - Street 1:7123 PEARL RD STE 201
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4944
Practice Address - Country:US
Practice Address - Phone:440-842-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28214923A363L00000X
OHCOA.11637-NP363L00000X
OHCOA 11637-NP146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant