Provider Demographics
NPI:1982908869
Name:JOHNSON, MICHELLE PLUMIE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:PLUMIE
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 1:19219 CHERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2703
Mailing Address - Country:US
Mailing Address - Phone:216-921-2914
Mailing Address - Fax:
Practice Address - Street 1:19219 CHERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2703
Practice Address - Country:US
Practice Address - Phone:216-921-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 127518 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse