Provider Demographics
NPI:1275278897
Name:JOHNSON, HILLERY NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:HILLERY
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:HILLERY
Other - Middle Name:NICOLE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:437 NE POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6920
Mailing Address - Country:US
Mailing Address - Phone:619-756-5373
Mailing Address - Fax:
Practice Address - Street 1:437 NE POPLAR LN
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6920
Practice Address - Country:US
Practice Address - Phone:619-756-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202009369NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty