Healthcare Provider Details

I. General information

NPI: 1538813167
Provider Name (Legal Business Name): JODI C HART ARNP, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JODI JOHNSON

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 NE BLAKELY DR STE 4020
ISSAQUAH WA
98029-6201
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 425-313-7124
  • Fax: 425-313-7072
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61166144
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN61166141
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: