Provider Demographics
NPI:1417357435
Name:JOHNSON, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
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 1:25300 ROCKSIDE RD
Mailing Address - Street 2:APARTMENT 423-B
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1940
Mailing Address - Country:US
Mailing Address - Phone:216-609-2718
Mailing Address - Fax:
Practice Address - Street 1:25300 ROCKSIDE RD
Practice Address - Street 2:APARTMENT 423-B
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1940
Practice Address - Country:US
Practice Address - Phone:216-609-2718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438866Medicaid