Healthcare Provider Details

I. General information

NPI: 1699847061
Provider Name (Legal Business Name): SARAH KJERSTEN JOHNSON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 NE 4TH ST
RENTON WA
98056-4122
US

IV. Provider business mailing address

307 NE 8TH ST
NORTH BEND WA
98045-7920
US

V. Phone/Fax

Practice location:
  • Phone: 206-205-1674
  • Fax: 206-205-1711
Mailing address:
  • Phone: 206-205-1674
  • Fax: 206-205-1711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI00001586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: