Provider Demographics
NPI:1316752322
Name:JOHNSON, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
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 1:3922 MCDOUGALL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-1665
Mailing Address - Country:US
Mailing Address - Phone:313-728-2943
Mailing Address - Fax:
Practice Address - Street 1:1325 CHENE ST APT 315
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3847
Practice Address - Country:US
Practice Address - Phone:313-728-2943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-08
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No174200000XOther Service ProvidersMeals
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No376J00000XNursing Service Related ProvidersHomemaker