Provider Demographics
NPI:1578772653
Name:JOHNSON, DOLORES LORRAINE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:LORRAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 61094
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23466-9998
Mailing Address - Country:US
Mailing Address - Phone:757-499-4949
Mailing Address - Fax:757-499-0648
Practice Address - Street 1:293 INDEPENDENCE BLVD
Practice Address - Street 2:BLDG 5 SUITE 330
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5402
Practice Address - Country:US
Practice Address - Phone:757-499-4949
Practice Address - Fax:757-499-0648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164367363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner