Provider Demographics
NPI:1316725559
Name:JOHNSON, C'JOLI F (CNA)
Entity type:Individual
Prefix:
First Name:C'JOLI
Middle Name:F
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 MAIN ST # 253
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2732
Mailing Address - Country:US
Mailing Address - Phone:845-401-2909
Mailing Address - Fax:
Practice Address - Street 1:242 MAIN ST # 253
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-2732
Practice Address - Country:US
Practice Address - Phone:845-401-2909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health