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General NPI Number Information
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NPI Number | 1558553693
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Entity Type | Individual
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Provider Name | JENNIFER JOHNSON CARLSON FNP
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1905 SE 164TH AVE
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City | VANCOUVER
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State | WA
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Zip | 98683-8937
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Country | US
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Telephone | 360-836-3396
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3158
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City | PORTLAND
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State | OR
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Zip | 97208-3158
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 200750023NP
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License Number State | OR
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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 | AP30007648
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License Number State | WA
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