Provider Demographics
NPI:1255812764
Name:JOHNSON, DAPHNE (RN)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 ANNAPOLIS RD STE B1
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3151
Mailing Address - Country:US
Mailing Address - Phone:301-327-4450
Mailing Address - Fax:
Practice Address - Street 1:9320 ANNAPOLIS RD STE B1
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3151
Practice Address - Country:US
Practice Address - Phone:301-327-4450
Practice Address - Fax:800-381-3367
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185736163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health