Provider Demographics
NPI:1730699349
Name:MCCLUSKEY, JOHNISHA JANELLE (STNA)
Entity type:Individual
Prefix:
First Name:JOHNISHA
Middle Name:JANELLE
Last Name:MCCLUSKEY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1131
Mailing Address - Country:US
Mailing Address - Phone:513-280-3506
Mailing Address - Fax:
Practice Address - Street 1:2204 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1131
Practice Address - Country:US
Practice Address - Phone:513-280-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid