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NPI Code Detail

MEDICARE: JOANDRA CORNELIUS-JOHNSON

MEDICARE: JOANDRA CORNELIUS-JOHNSON
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
13747P1801XPersonal Care Attendant

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093103913
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANDRA CORNELIUS-JOHNSON
Provider Business Mailing Address
First Line : 1400 COTTONWOOD PL
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-1702
Country : US
Telephone Number : 702-326-8594
Fax Number :
Provider Business Practice Location Address
First Line : 1600 E DESERT INN RD STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89169-2505
Country : US
Telephone Number : 702-326-8594
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2014
Last Update Date : 02/24/2018

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Directions to “ JOANDRA CORNELIUS-JOHNSON ” Practice Location

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