Provider Demographics
NPI:1306509682
Name:JOHNSON-MAKALENA, RUTH ALLEEN (REGISTERD NURSE)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ALLEEN
Last Name:JOHNSON-MAKALENA
Suffix:
Gender:F
Credentials:REGISTERD NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 ROGER BROOK DR.
Mailing Address - Street 2:ATTN: MCHE-ZDF-M
Mailing Address - City:JBSA-FORT SAM HOUSON
Mailing Address - State:TX
Mailing Address - Zip Code:78234
Mailing Address - Country:US
Mailing Address - Phone:210-539-0919
Mailing Address - Fax:210-539-0203
Practice Address - Street 1:10010 ROGERS XING STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4766
Practice Address - Country:US
Practice Address - Phone:210-539-0919
Practice Address - Fax:201-539-0203
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX968240163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX968240OtherREGISTERED NURSE