Provider Demographics
NPI:1194110353
Name:OMAJERE, JOHNSON
Entity type:Individual
Prefix:
First Name:JOHNSON
Middle Name:
Last Name:OMAJERE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 CAMBRIDGE PARK
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-4457
Mailing Address - Country:US
Mailing Address - Phone:516-330-4673
Mailing Address - Fax:
Practice Address - Street 1:4811 CAMBRIDGE PARK
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-4457
Practice Address - Country:US
Practice Address - Phone:516-330-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY779962163W00000X
NY320933164W00000X
TX336291164X00000X
TX979399163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse