MEDICARE: DEJAH JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372600000X	Adult Companion

General Provider Information

NPI Number	:	1093515504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEJAH JOHNSON

Provider Business Mailing Address
First Line	:	287 N 115TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2520
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 N 120TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-3477
Country	:	US
Telephone Number	:	402-502-5352
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2025
Last Update Date	:	03/14/2025

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Directions to “ DEJAH JOHNSON ” Practice Location

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