Provider Demographics
NPI:1588429815
Name:JOHNSON, BRENDA (AFH-HOME CARE AID)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AFH-HOME CARE AID
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:MARIE
Other - Last Name:REMBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8118 44TH ST W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-2302
Mailing Address - Country:US
Mailing Address - Phone:425-428-8743
Mailing Address - Fax:
Practice Address - Street 1:802 MLK JR WAY # 404
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402
Practice Address - Country:US
Practice Address - Phone:253-650-0498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty