Provider Demographics
NPI:1528931060
Name:JOHNSON, PAMELLA JO
Entity type:Individual
Prefix:
First Name:PAMELLA
Middle Name:JO
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 1:204 5TH AVE SE APT 8
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-4050
Mailing Address - Country:US
Mailing Address - Phone:701-641-7471
Mailing Address - Fax:
Practice Address - Street 1:204 5TH AVE SE APT 8
Practice Address - Street 2:APT 8
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-4050
Practice Address - Country:US
Practice Address - Phone:701-641-7471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker