Provider Demographics
NPI:1255047809
Name:JOHNSON, ERIS MARSHNIA X
Entity type:Individual
Prefix:MS
First Name:ERIS
Middle Name:MARSHNIA X
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERIS
Other - Middle Name:MARSHNIA X
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICENSE MT
Mailing Address - Street 1:1413 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-1774
Mailing Address - Country:US
Mailing Address - Phone:313-753-1893
Mailing Address - Fax:
Practice Address - Street 1:1413 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-1774
Practice Address - Country:US
Practice Address - Phone:313-753-1893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist