Healthcare Provider Details

I. General information

NPI: 1891732616
Provider Name (Legal Business Name): DEVENA E ALSTON-JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 MAHALANI ST # 808244-9
WAILUKU HI
96793-2526
US

IV. Provider business mailing address

348 VINTAGE POINT LN
WENDELL NC
27591-6858
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-4425
  • Fax: 855-827-2321
Mailing address:
  • Phone: 219-380-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number01040872A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2008-01388
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number32825
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD-22093
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: