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General NPI Number Information
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NPI Number | 1225298797
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Entity Type | Individual
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Provider Name | ALICIA KATHERINE JOHNSON LMP,
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Gender | Female
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 1207 SE RASMUSSEN BLVD STE 111
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City | BATTLE GROUND
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State | WA
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Zip | 98604-8618
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Country | US
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Telephone | 360-607-7368
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Fax |
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Provider Business Mailing Address
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Address Line | 1207 SE RASMUSSEN BLVD STE 111
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City | BATTLE GROUND
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State | WA
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Zip | 98604-8618
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Country | US
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Telephone | 360-607-7368
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Fax |
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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 | 305S00000X
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Taxonomy Name | Point of Service
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License Number | MA00024163
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License Number State | WA
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