Healthcare Provider Details

I. General information

NPI: 1346636644
Provider Name (Legal Business Name): LAUREN RENE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 12/25/2023
Certification Date: 12/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE STE 7010
SPOKANE WA
99204-2312
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-1144
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number68900-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD60762730
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: