Healthcare Provider Details

I. General information

NPI: 1063164887
Provider Name (Legal Business Name): JOAN M JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 R ST NW APT 302
WASHINGTON DC
20001-1949
US

IV. Provider business mailing address

101 Q ST NW APT 201
WASHINGTON DC
20001-1157
US

V. Phone/Fax

Practice location:
  • Phone: 202-378-8612
  • Fax:
Mailing address:
  • Phone: 202-717-0713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: