=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023112471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GAIL JOHNSON ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 01/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6020 35TH AVE SW
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98126-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-461-6950
-----------------------------------------------------
Fax | 206-461-8542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 12TH AVE S SUITE 901
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98144-2712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-548-3114
-----------------------------------------------------
Fax | 206-762-6355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | AP30001780
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN00067960
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------