Provider Demographics
NPI:1518767268
Name:JOHNSON, CYNTHIA YVONNE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:YVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:Y
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:2170 ROUNTREE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6135
Mailing Address - Country:US
Mailing Address - Phone:314-956-4482
Mailing Address - Fax:
Practice Address - Street 1:231 S BEMISTON AVE STE 800
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1925
Practice Address - Country:US
Practice Address - Phone:314-303-5734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC001687743347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle