Healthcare Provider Details

I. General information

NPI: 1467374488
Provider Name (Legal Business Name): JORDANNE ELIZABETH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COOPER POINT RD SW STE 100
OLYMPIA WA
98502-1160
US

IV. Provider business mailing address

700 LILLY RD NE
OLYMPIA WA
98506-5115
US

V. Phone/Fax

Practice location:
  • Phone: 360-923-7000
  • Fax: 360-923-7089
Mailing address:
  • Phone: 360-923-7000
  • Fax: 360-923-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: