Healthcare Provider Details

I. General information

NPI: 1104313188
Provider Name (Legal Business Name): HILLARY DANIELLE JOHNSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HILLARY KONSURE DO

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 11/20/2022
Certification Date: 11/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 AMES AVE
OMAHA NE
68104-2323
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-2439
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2695
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2695
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: