Provider Demographics
NPI:1285469932
Name:JOHNSON, TRIMINIA
Entity type:Individual
Prefix:
First Name:TRIMINIA
Middle Name:
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 1:10888 MANSFIELD WAY
Mailing Address - Street 2:
Mailing Address - City:INGALLS
Mailing Address - State:IN
Mailing Address - Zip Code:46048-9510
Mailing Address - Country:US
Mailing Address - Phone:317-765-3885
Mailing Address - Fax:
Practice Address - Street 1:10888 MANSFIELD WAY
Practice Address - Street 2:
Practice Address - City:INGALLS
Practice Address - State:IN
Practice Address - Zip Code:46048-9510
Practice Address - Country:US
Practice Address - Phone:317-765-3885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-01795-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health