| NPI | 1548751340 |
|---|---|
| Former Name | SHANTA MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health (Licence: AL 18023894) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 374U00000X Home Health Aide (Licence: AL 18023894) | |
| 374U00000X Home Health Aide (Licence: AL 000000000) | |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-04-30 |