Healthcare Provider Details

I. General information

NPI: 1679762165
Provider Name (Legal Business Name): BETSY ANNE JOHNSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 03/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1742 MARKET ST STE. 102
TACOMA WA
98402-3223
US

IV. Provider business mailing address

1742 MARKET ST STE. 102
TACOMA WA
98402-3223
US

V. Phone/Fax

Practice location:
  • Phone: 253-692-5811
  • Fax: 253-692-4768
Mailing address:
  • Phone: 253-692-5811
  • Fax: 253-692-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30004909
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: