Healthcare Provider Details

I. General information

NPI: 1518929405
Provider Name (Legal Business Name): DEBRA F JOHNSON PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA A FIGUEROA

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030-3794
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030-3794
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8176
  • Fax: 503-665-8178
Mailing address:
  • Phone: 503-665-8176
  • Fax: 503-665-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN059093
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201601734NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: