Provider Demographics
NPI:1871385369
Name:JOHNSON, DANYELL MARIE (PERSONAL CARE SERV)
Entity type:Individual
Prefix:
First Name:DANYELL
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PERSONAL CARE SERV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3812
Mailing Address - Country:US
Mailing Address - Phone:317-945-0683
Mailing Address - Fax:219-264-2074
Practice Address - Street 1:556 LYNN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3812
Practice Address - Country:US
Practice Address - Phone:317-945-0683
Practice Address - Fax:219-264-2074
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN25-018776-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care