Individual
MARCIA MICHELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
737 DERBY WAY DR, WENTZVILLE, MO 63385-4711
(402) 969-0094
Mailing address
10407 DURNESS DR, SAINT LOUIS, MO 63137-3758
(314) 667-8149
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LC001601639
HOME CARE
MO
Enumeration date
08/31/2019
Last updated
08/31/2019
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