MEDICARE: MR. CAMERON R JOHNSON I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073142584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CAMERON R JOHNSON I

Provider Business Mailing Address
First Line	:	2581 CASCADE CREEK DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3771
Country	:	US
Telephone Number	:	517-416-8547
Fax Number	:

Provider Business Practice Location Address
First Line	:	2581 CASCADE CREEK DR
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-3771
Country	:	US
Telephone Number	:	517-416-8547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2020
Last Update Date	:	04/06/2020

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Directions to “ MR. CAMERON R JOHNSON I ” Practice Location

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