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General NPI Number Information
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NPI Number | 1356966147
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Entity Type | Individual
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Provider Name | SANDRA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 01/06/2021
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Provider Practice Location Address
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Address Line | 2055 WALTON RD STE 302
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City | OVERLAND
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State | MO
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Zip | 63114-5805
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Country | US
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Telephone | 314-249-4944
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Fax |
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Provider Business Mailing Address
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Address Line | 818 SPRINTERS ROW DR
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City | FLORISSANT
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State | MO
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Zip | 63034-3365
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Country | US
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Telephone | 314-249-4944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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