Healthcare Provider Details

I. General information

NPI: 1790355774
Provider Name (Legal Business Name): JOHANA MARIE HURST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANA MARIE MORRISON RN

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 PARK CIR
HINGHAM MA
02043-1227
US

IV. Provider business mailing address

16 PARK CIR
HINGHAM MA
02043-1227
US

V. Phone/Fax

Practice location:
  • Phone: 703-463-1556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0001271688
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2351951
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: