1225180847 NPI number — MRS. MARCELINA ANNETTE JOHNSON MPT

Table of content: MRS. MARCELINA ANNETTE JOHNSON MPT (NPI 1225180847)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225180847 NPI number — MRS. MARCELINA ANNETTE JOHNSON MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MARCELINA
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
MARCE
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225180847
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2167 QUAIL MEADOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-342-4210
Provider Business Mailing Address Fax Number:
972-797-0691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2167 QUAIL MEADOW LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-2621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-342-4210
Provider Business Practice Location Address Fax Number:
972-797-0691
Provider Enumeration Date:
01/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1215863 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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