Individual
JOHNNA FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12416 FARNAM ST, OMAHA, NE 68154-2333
(573) 629-8106
Mailing address
300 N DOGWOOD ST APT A, SAVANNAH, MO 64485-9440
(573) 629-8106
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
—
Other
Enumeration date
01/25/2025
Last updated
01/25/2025
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