Provider Demographics
NPI:1093570475
Name:JOHNSON, HALLEY MARIE
Entity Type:Individual
Prefix:
First Name:HALLEY
Middle Name:MARIE
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 1:480 LANCASTER PIKE APT 128
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-9285
Mailing Address - Country:US
Mailing Address - Phone:740-918-9552
Mailing Address - Fax:
Practice Address - Street 1:480 LANCASTER PIKE APT 128
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-9285
Practice Address - Country:US
Practice Address - Phone:740-918-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant