Provider Demographics
NPI:1649092073
Name:HAMPTON, JOHNNIE LEE (STNA)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:LEE
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2337 VALENTINE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1275
Mailing Address - Country:US
Mailing Address - Phone:567-225-7222
Mailing Address - Fax:
Practice Address - Street 1:2337 VALENTINE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1275
Practice Address - Country:US
Practice Address - Phone:567-225-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400103960402376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide