MEDICARE: BEATRICE K JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1912070806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE K JOHNSON

Provider Business Mailing Address
First Line	:	1144 W 7TH ALY APT 1
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97402-4660
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Provider Business Practice Location Address
First Line	:	847 NE 19TH AVE
Second Line	:	SUITE 100
City	:	PORTLAND
State	:	OR
Zip	:	97232-2684
Country	:	US
Telephone Number	:	503-238-0769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/25/2016

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