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General NPI Number Information
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NPI Number | 1780182584
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Entity Type | Individual
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Provider Name | ROBERTA LYNN JOHNSON LPN
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Gender | Female
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Dates
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Enumeration Date | 01/26/2018
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | INTREPID SPIRIT CENTER 90390 GARDNER LOOP
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-9017
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Fax |
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Provider Business Mailing Address
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Address Line | 8634 QUINAULT DR NE
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City | OLYMPIA
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State | WA
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Zip | 98516-5826
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Country | US
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Telephone | 360-789-5261
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LPN00047974
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License Number State | WA
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