Healthcare Provider Details

I. General information

NPI: 1851891139
Provider Name (Legal Business Name): ANDREA MAYA JOHNSON LM, CPM, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MAYA ODA

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24920 104TH AVE SE
KENT WA
98030-6443
US

IV. Provider business mailing address

955 POWELL AVE SW
RENTON WA
98057-2908
US

V. Phone/Fax

Practice location:
  • Phone: 253-876-3939
  • Fax: 253-876-3940
Mailing address:
  • Phone: 425-277-1311
  • Fax: 425-277-1566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60805661
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: