Provider Demographics
NPI:1689006470
Name:JOHNSON, GERON DEMARCUS (REGISTERED NURSE)
Entity type:Individual
Prefix:MR
First Name:GERON
Middle Name:DEMARCUS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SKYHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48604-1820
Mailing Address - Country:US
Mailing Address - Phone:989-992-6739
Mailing Address - Fax:
Practice Address - Street 1:500 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4224
Practice Address - Country:US
Practice Address - Phone:989-272-7276
Practice Address - Fax:989-272-7279
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704286834163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse