Provider Demographics
NPI:1548059256
Name:JOHNSON, CRYSTAL DENISE
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DENISE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5536 YORKSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2141
Mailing Address - Country:US
Mailing Address - Phone:313-392-3769
Mailing Address - Fax:313-392-3769
Practice Address - Street 1:5536 YORKSHIRE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48224-2141
Practice Address - Country:US
Practice Address - Phone:313-210-3736
Practice Address - Fax:313-392-3769
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula