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NPI Code Detail

MEDICARE: LATISHA JOHNSON

MEDICARE: LATISHA 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
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1669821468
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATISHA JOHNSON
Provider Business Mailing Address
First Line : 4218 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6121
Country : US
Telephone Number : 616-301-8000
Fax Number :
Provider Business Practice Location Address
First Line : 4218 BURTON ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-6121
Country : US
Telephone Number : 616-301-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2016
Last Update Date : 01/12/2023

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Directions to “ LATISHA JOHNSON ” Practice Location

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