Provider Demographics
NPI:1588352835
Name:JOHNSON, BRIDGET CAMILLE
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:CAMILLE
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 1:1036 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-3712
Mailing Address - Country:US
Mailing Address - Phone:937-305-0305
Mailing Address - Fax:
Practice Address - Street 1:1036 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-3712
Practice Address - Country:US
Practice Address - Phone:937-305-0305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant