MEDICARE: MS. MARVENE 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	171WH0202X	Home Modifications Contractor		TX

General Provider Information

NPI Number	:	1912038332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARVENE JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 36408
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77236-6408
Country	:	US
Telephone Number	:	713-541-6449
Fax Number	:	713-270-7138

Provider Business Practice Location Address
First Line	:	6423 INDIGO ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-7202
Country	:	US
Telephone Number	:	713-541-6449
Fax Number	:	713-270-7138

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

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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