Provider Demographics
NPI:1982326922
Name:JOHNSON, TANYA (CHW)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WRIGHT ST STE A
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-1837
Mailing Address - Country:US
Mailing Address - Phone:906-936-0921
Mailing Address - Fax:906-936-0911
Practice Address - Street 1:1200 WRIGHT ST STE A
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-1837
Practice Address - Country:US
Practice Address - Phone:906-936-0921
Practice Address - Fax:906-936-0911
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker