Provider Demographics
NPI:1558189829
Name:UMOSEN, JOHANNA (RN)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:
Last Name:UMOSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 DOVES LANDING LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4836
Mailing Address - Country:US
Mailing Address - Phone:214-457-2327
Mailing Address - Fax:
Practice Address - Street 1:2546 CUMBERLAND DR
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-5207
Practice Address - Country:US
Practice Address - Phone:214-457-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX946047163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice