Healthcare Provider Details

I. General information

NPI: 1386201192
Provider Name (Legal Business Name): MARLA JOHANESEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2334 LUMMI VIEW DR
BELLINGHAM WA
98226-9277
US

IV. Provider business mailing address

6067 GUIDE MERIDIAN
BELLINGHAM WA
98226-9751
US

V. Phone/Fax

Practice location:
  • Phone: 360-758-4369
  • Fax:
Mailing address:
  • Phone: 360-483-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN60578829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: