Provider Demographics
NPI:1528785540
Name:MCCONNELL, JOHANNAH
Entity type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:
Last Name:MCCONNELL
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 1:649 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NELSONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45764-9745
Mailing Address - Country:US
Mailing Address - Phone:740-517-3935
Mailing Address - Fax:
Practice Address - Street 1:649 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NELSONVILLE
Practice Address - State:OH
Practice Address - Zip Code:45764-9745
Practice Address - Country:US
Practice Address - Phone:740-517-3935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide