Healthcare Provider Details

I. General information

NPI: 1851373799
Provider Name (Legal Business Name): LAURA SCHELLENBERG JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA CHRISTINE SCHELLENBERG-JOHNSON M.D.

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST # MS 105
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-2560
  • Fax: 425-899-2079
Mailing address:
  • Phone: 425-899-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberMD00043961
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: