Healthcare Provider Details

I. General information

NPI: 1700092087
Provider Name (Legal Business Name): LAURIE JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGAS DR
SITKA AK
99835
US

IV. Provider business mailing address

1806 ALDER WAY APT D
SITKA AK
99835-9633
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8318
  • Fax: 907-966-8444
Mailing address:
  • Phone: 907-747-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number6029
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: