MEDICARE: JASON J JOHNSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WA2000X	Administrator Registered Nurse	2002409162RN	OR

General Provider Information

NPI Number	:	1003316183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON J JOHNSON RN

Provider Business Mailing Address
First Line	:	6464 SW BORLAND RD STE C1
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8856
Country	:	US
Telephone Number	:	503-878-5412
Fax Number	:

Provider Business Practice Location Address
First Line	:	6464 SW BORLAND RD STE C1
Second Line	:
City	:	TUALATIN
State	:	OR
Zip	:	97062-8856
Country	:	US
Telephone Number	:	503-878-5412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2018
Last Update Date	:	02/15/2018

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