MEDICARE: DEBRA JOHNSON RN

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	358972	OH

General Provider Information

NPI Number	:	1215715206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA JOHNSON RN

Provider Business Mailing Address
First Line	:	6685 LONDON RD
Second Line	:
City	:	SOUTH CHARLESTON
State	:	OH
Zip	:	45368-9632
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 S BURNETT RD
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-2628
Country	:	US
Telephone Number	:	937-688-3743
Fax Number	:

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

Provider Enumeration Date	:	09/20/2023
Last Update Date	:	09/20/2023

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