Healthcare Provider Details

I. General information

NPI: 1790864379
Provider Name (Legal Business Name): SUSANNE JANE JOHNSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 BROADWAY
SEATTLE WA
98122-4379
US

IV. Provider business mailing address

10059 LAKE SHORE BLVD NE
SEATTLE WA
98125-8157
US

V. Phone/Fax

Practice location:
  • Phone: 206-693-3288
  • Fax:
Mailing address:
  • Phone: 206-693-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAP30007632
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN00168047
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: