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General NPI Number Information
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NPI Number | 1598445959
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Entity Type | Individual
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Provider Name | MICHELLE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 2809 BUNTING AVE
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6500
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Country | US
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Telephone | 970-254-8888
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Fax | 970-240-3021
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Provider Business Mailing Address
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Address Line | 301 N PAGOSA BLVD UNIT B10
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-7012
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Country | US
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Telephone | 970-264-5991
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Fax | 970-264-5919
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 04H131
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License Number State | CO
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