Healthcare Provider Details

I. General information

NPI: 1427101963
Provider Name (Legal Business Name): LINDA P JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE MCHD
SALEM OR
97301-4532
US

IV. Provider business mailing address

815 MADISON ST
SILVERTON OR
97381-2327
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5622
  • Fax: 503-361-2657
Mailing address:
  • Phone: 503-873-6786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: