Provider Demographics
NPI:1629542642
Name:JOHNSON, HYLA BLONDELL
Entity type:Individual
Prefix:MS
First Name:HYLA
Middle Name:BLONDELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 HUGUENOT RD STE 304
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4314
Mailing Address - Country:US
Mailing Address - Phone:804-533-9655
Mailing Address - Fax:804-794-1297
Practice Address - Street 1:1909 HUGUENOT RD STE 304
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4314
Practice Address - Country:US
Practice Address - Phone:804-533-9655
Practice Address - Fax:804-794-1297
Is Sole Proprietor?:No
Enumeration Date:2019-01-12
Last Update Date:2019-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401001845376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide