MEDICARE: DALE 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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1881171254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE JOHNSON

Provider Business Mailing Address
First Line	:	112 O ST SW APT 1
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20024-3501
Country	:	US
Telephone Number	:	202-292-7634
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 WHEELER RD SE UNIT F
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4376
Country	:	US
Telephone Number	:	202-652-0120
Fax Number	:

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

Provider Enumeration Date	:	07/27/2018
Last Update Date	:	07/27/2018

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Directions to “ DALE JOHNSON ” Practice Location

Language	Start Address	Practice Location

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