Provider Demographics
NPI:1962709840
Name:JOHNSON, JOY
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOY
Other - Middle Name:
Other - Last Name:AIMUFUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:19221 BEECHNUT ST APT 333
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5212
Mailing Address - Country:US
Mailing Address - Phone:347-257-4341
Mailing Address - Fax:
Practice Address - Street 1:19221 BEECHNUT ST APT 333
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5212
Practice Address - Country:US
Practice Address - Phone:347-257-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY634542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse