Healthcare Provider Details

I. General information

NPI: 1689420440
Provider Name (Legal Business Name): KAREN LYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 BIDDULPH RD
BROOKLYN OH
44144-3346
US

IV. Provider business mailing address

6303 BIDDULPH RD
BROOKLYN OH
44144-3346
US

V. Phone/Fax

Practice location:
  • Phone: 216-534-0602
  • Fax:
Mailing address:
  • Phone: 216-534-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: