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General NPI Number Information
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NPI Number | 1730047655
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Entity Type | Individual
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Provider Name | DANIEL ROBERT JOHNSEN
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Gender | Male
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Dates
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Enumeration Date | 01/10/2026
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Last Update Date | 01/10/2026
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Provider Practice Location Address
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Address Line | 12350 SE POWELL BLVD
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City | PORTLAND
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State | OR
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Zip | 97236-3432
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Country | US
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Telephone | 503-477-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 4546 SE FRANKLIN ST
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City | PORTLAND
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State | OR
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Zip | 97206-3115
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Country | US
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Telephone | 503-477-2542
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 113538
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License Number State | OR
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