Individual
MS. ILLYA JOHNSON-HICKLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RCP
Contact information
Practice address
CORNER OF ROUTE N12 AND, ROUTE N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
Taxonomy
Speciality
Code
Description
License number
State
2278C0205X
Critical Care Certified Respiratory Therapist
Primary
RCP02003641
TX
Other
Enumeration date
12/23/2022
Last updated
12/23/2022
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