Healthcare Provider Details

I. General information

NPI: 1912038332
Provider Name (Legal Business Name): MS. MARVENE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6423 INDIGO ST
HOUSTON TX
77074-7202
US

IV. Provider business mailing address

PO BOX 36408
HOUSTON TX
77236-6408
US

V. Phone/Fax

Practice location:
  • Phone: 713-541-6449
  • Fax: 713-270-7138
Mailing address:
  • Phone: 713-541-6449
  • Fax: 713-270-7138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: