Healthcare Provider Details

I. General information

NPI: 1841303856
Provider Name (Legal Business Name): SHANA L JOHNSON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANA L BURTON CNM

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 NE 130TH LN SUITE 225
KIRKLAND WA
98034-3099
US

IV. Provider business mailing address

12303 NE 130TH LN SUITE 225
KIRKLAND WA
98034-3099
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4012
  • Fax: 425-899-4013
Mailing address:
  • Phone: 425-899-4012
  • Fax: 425-899-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60052156
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number200250004NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200141902RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00175004
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: