Healthcare Provider Details

I. General information

NPI: 1760017610
Provider Name (Legal Business Name): NAVI JOHAL NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date: 02/14/2021
Reactivation Date: 11/09/2021

III. Provider practice location address

1700 5TH ST SE STE 200
PUYALLUP WA
98372-4683
US

IV. Provider business mailing address

PO BOX 860912
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 253-697-8200
  • Fax: 253-697-8220
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number12003
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAP61598034
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number12003
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP61598034
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: