Healthcare Provider Details

I. General information

NPI: 1063316289
Provider Name (Legal Business Name): ANTONIKA VICTORIA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 DOUGLAS ST NE
WASHINGTON DC
20018-1546
US

IV. Provider business mailing address

3023 DOUGLAS ST NE
WASHINGTON DC
20018-1546
US

V. Phone/Fax

Practice location:
  • Phone: 202-415-3983
  • Fax:
Mailing address:
  • Phone: 202-415-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: