Provider Demographics
NPI:1962883017
Name:JOHNSON, AMANDA DANIELLE
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:DANIELLE
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 1:161 WYNDCREST CT
Mailing Address - Street 2:B
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1791
Mailing Address - Country:US
Mailing Address - Phone:513-620-9546
Mailing Address - Fax:
Practice Address - Street 1:161 WYNDCREST CT
Practice Address - Street 2:B
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1791
Practice Address - Country:US
Practice Address - Phone:513-620-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401371460412376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide