1427024132 NPI number — CHERIE H JOHNSON DPM

Table of content: CHERIE H JOHNSON DPM (NPI 1427024132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427024132 NPI number — CHERIE H JOHNSON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
CHERIE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427024132
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 NASSAU ST
Provider Second Line Business Mailing Address:
SUITE #101
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-4137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-339-8888
Provider Business Mailing Address Fax Number:
425-258-6933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 NASSAU ST
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-339-8888
Provider Business Practice Location Address Fax Number:
425-258-6933
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO00000583 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5996724 . This is a "AETNA U.S. HEALTHCARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 120018 . This is a "WORKER'S COMPENSATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: J01543 . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1104322 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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