MEDICARE: MISS ANGELA RICHELLE JOHNSON RN

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	163W00000X	Registered Nurse	59142	OK

General Provider Information

NPI Number	:	1821316183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGELA RICHELLE JOHNSON RN

Provider Business Mailing Address
First Line	:	4633 NW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-1331
Country	:	US
Telephone Number	:	405-601-8891
Fax Number	:

Provider Business Practice Location Address
First Line	:	4633 NW 35TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-1331
Country	:	US
Telephone Number	:	405-601-8891
Fax Number	:

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

Provider Enumeration Date	:	05/12/2010
Last Update Date	:	05/12/2010

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