Individual
DEMETRIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11206 ABBOTS CROSS LN, GLEN ALLEN, VA 23059-1106
(516) 410-7618
Mailing address
4990 SADLER PL UNIT 2621, GLEN ALLEN, VA 23058-1225
(516) 410-7618
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
0001264629
VA
Other
Enumeration date
09/22/2023
Last updated
09/22/2023
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