National Provider Identifier
Detric D Johnson
Detric D Johnson is listed in the NPPES registry with a primary specialty of Community Health Worker in Buffalo, NY and a listed phone number of (716) 253-1847.
Profile Overview
- NPI
- 1568958890
- Provider Type
- Individual
- Primary Specialty
- Community Health Worker
- Enumeration Date
- July 10, 2018
- Last Updated
- June 06, 2019
Practice Location
- 535 Wyoming Ave Ste 1
- Buffalo, NY 14215-3137
Phone: (716) 253-1847
Specialties
- Community Health Worker (172V00000X)
Full Record
- NPI
- 1568958890
- Entity Type
- Individual
- Last Name
- Johnson
- First Name
- Detric
- Middle Name
- D
- Mailing Street Address
- 535 Wyoming Ave Ste 1
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14215-3137
- Mailing Country
- US
- Mailing Phone
- (716) 253-1847
- Mailing Fax
- (716) 845-3511
- Practice Street Address
- 535 Wyoming Ave Ste 1
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14215-3137
- Practice Country
- US
- Practice Phone
- (716) 253-1847
- Practice Fax
- (716) 845-3511
- Enumeration Date
- July 10, 2018
- Last Updated
- June 06, 2019
- Sex
- Female
- Sole Proprietor
- No
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Community Health Worker (172V00000X)