Provider Demographics
NPI:1114686938
Name:HYMAN'JOHNSON, ANDREALE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANDREALE
Middle Name:
Last Name:HYMAN'JOHNSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 TOWN HALL DR APT C4
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:12534-1228
Mailing Address - Country:US
Mailing Address - Phone:518-929-3872
Mailing Address - Fax:
Practice Address - Street 1:300 TOWN HALL DR APT C4
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1228
Practice Address - Country:US
Practice Address - Phone:518-929-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310542164W00000X
NY310541164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse