Provider Demographics
NPI:1992136881
Name:REDHEAD-JOSEPH, JOHNIA (RN)
Entity type:Individual
Prefix:
First Name:JOHNIA
Middle Name:
Last Name:REDHEAD-JOSEPH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOHNIA
Other - Middle Name:
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:5224 BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1603
Mailing Address - Country:US
Mailing Address - Phone:347-727-9658
Mailing Address - Fax:
Practice Address - Street 1:5224 BROOK WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-1603
Practice Address - Country:US
Practice Address - Phone:347-727-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-03
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676122163W00000X
DCRN1041771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse