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General NPI Number Information
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NPI Number | 1235259748
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Entity Type | Individual
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Provider Name | CHARMAINE R ALLEN-JOHNSON ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 10/26/2010
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Provider Practice Location Address
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Address Line | 619 DIAGONAL ST
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City | CLARKSTON
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State | WA
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Zip | 99403-2041
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Country | US
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Telephone | 509-758-9003
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Fax | 509-758-9001
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Provider Business Mailing Address
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Address Line | 165 SOUTHPORT AVE
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City | LEWISTON
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State | ID
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Zip | 83501-4523
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Country | US
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Telephone | 208-743-3142
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Fax | 208-743-3142
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP3005439
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP451A
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License Number State | ID
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