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General NPI Number Information
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NPI Number | 1104703313
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Entity Type | Individual
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Provider Name | NICOLE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 08/19/2025
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 2322 196TH ST SW
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City | LYNNWOOD
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State | WA
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Zip | 98036-7010
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Country | US
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Telephone | 425-984-0788
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Fax |
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Provider Business Mailing Address
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Address Line | 20043 FOREST PARK DR NE
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City | SHORELINE
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State | WA
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Zip | 98155-1139
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Country | US
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Telephone | 254-768-3870
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Fax | 254-768-3870
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 335371
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License Number State | TX
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