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General NPI Number Information
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NPI Number | 1912187378
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Entity Type | Individual
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Provider Name | CARLA JOHNSON LMP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 1206 N DOLARWAY RD SUITE # 211
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City | ELLENSBURG
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State | WA
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Zip | 98926-8392
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Country | US
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Telephone | 509-925-6869
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Fax |
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Provider Business Mailing Address
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Address Line | 2106 W CLEARVIEW DR
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City | ELLENSBURG
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State | WA
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Zip | 98926-2331
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Country | US
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Telephone | 509-899-1959
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Fax | 509-933-3658
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00023300
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License Number State | WA
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