Healthcare Provider Details

I. General information

NPI: 1568479897
Provider Name (Legal Business Name): KAREN ELAINE JOHNSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9782
US

IV. Provider business mailing address

1744 NE 143RD AVE
PORTLAND OR
97230-4112
US

V. Phone/Fax

Practice location:
  • Phone: 503-286-6868
  • Fax:
Mailing address:
  • Phone: 503-253-5190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1067
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: