Healthcare Provider Details

I. General information

NPI: 1275278897
Provider Name (Legal Business Name): HILLERY NICOLE JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HILLERY NICOLE SCOTT

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 NE POPLAR LN
REDMOND OR
97756-6920
US

IV. Provider business mailing address

437 NE POPLAR LN
REDMOND OR
97756-6920
US

V. Phone/Fax

Practice location:
  • Phone: 619-756-5373
  • Fax:
Mailing address:
  • Phone: 619-756-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number202009369NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: