Healthcare Provider Details

I. General information

NPI: 1053264804
Provider Name (Legal Business Name): RANDELLE JOHNSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 ENSIGN RD NE STE 220
OLYMPIA WA
98506-5063
US

IV. Provider business mailing address

3425 ENSIGN RD NE STE 220
OLYMPIA WA
98506-5063
US

V. Phone/Fax

Practice location:
  • Phone: 360-493-4019
  • Fax: 360-493-7479
Mailing address:
  • Phone: 360-493-4019
  • Fax: 360-493-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70137230-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: