1871894287 NPI number — MRS. JOHNSON MARIA FRIEDERIKE JOHNSON LMP

Table of content: MRS. JOHNSON MARIA FRIEDERIKE JOHNSON LMP (NPI 1871894287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871894287 NPI number — MRS. JOHNSON MARIA FRIEDERIKE JOHNSON LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JOHNSON
Provider Middle Name:
MARIA FRIEDERIKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMP
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:
1871894287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10316 107TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98498-1583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-306-3041
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 CENTER DR STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUPONT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98327-7734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-964-1559
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2010

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: 225700000X , with the licence number:  MA60141193 , 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)





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