Provider Demographics
NPI:1366613283
Name:JOHNSON, JO ELLEN
Entity type:Individual
Prefix:MRS
First Name:JO
Middle Name:ELLEN
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 1:1213 CHARLTON RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6171
Mailing Address - Country:US
Mailing Address - Phone:405-348-7904
Mailing Address - Fax:
Practice Address - Street 1:1213 CHARLTON RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6171
Practice Address - Country:US
Practice Address - Phone:405-348-7904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion