Provider Demographics
NPI:1205726817
Name:JOHNSON, MARQUITA M
Entity type:Individual
Prefix:
First Name:MARQUITA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 N 89TH CT # 8
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-4131
Mailing Address - Country:US
Mailing Address - Phone:402-709-9103
Mailing Address - Fax:
Practice Address - Street 1:6706 N 89TH CT # 8
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-4131
Practice Address - Country:US
Practice Address - Phone:402-709-9103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker