Provider Demographics
NPI:1114725405
Name:JOHNSON, THERESA M
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:MARIE
Other - Last Name:LINDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1148 E DODGE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5738
Mailing Address - Country:US
Mailing Address - Phone:402-660-7393
Mailing Address - Fax:
Practice Address - Street 1:1148 E DODGE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5738
Practice Address - Country:US
Practice Address - Phone:402-660-7393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist