Healthcare Provider Details

I. General information

NPI: 1962232934
Provider Name (Legal Business Name): CINNAMON JOHNAYE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 E GIRARD AVE
DENVER CO
80231-5040
US

IV. Provider business mailing address

9825 E GIRARD AVE
DENVER CO
80231-5040
US

V. Phone/Fax

Practice location:
  • Phone: 720-809-4476
  • Fax:
Mailing address:
  • Phone: 720-809-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN.1654682
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: