Healthcare Provider Details

I. General information

NPI: 1467356105
Provider Name (Legal Business Name): EVALYN GRACE JOHNSON-RAMSAY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVALYN GRACE JOHNSON

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10414 LIBERTY RD
RANDALLSTOWN MD
21133-1211
US

IV. Provider business mailing address

10414 LIBERTY RD
RANDALLSTOWN MD
21133-1211
US

V. Phone/Fax

Practice location:
  • Phone: 919-805-4775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPI03578
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: