Healthcare Provider Details

I. General information

NPI: 1750685665
Provider Name (Legal Business Name): STEVEN JOHNS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 LILLY RD NE STE 100
OLYMPIA WA
98506-5117
US

IV. Provider business mailing address

13712 68TH AVENUE CT E
PUYALLUP WA
98373-8711
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-4211
  • Fax: 360-493-0407
Mailing address:
  • Phone: 253-227-4971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number60272347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: