MEDICARE: SARAH JENAI JOHANSEN 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	163WH1000X	Hospice Registered Nurse	RN60643718	WA
2	363L00000X	Nurse Practitioner	AP70093357	WA

General Provider Information

NPI Number	:	1639911274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JENAI JOHANSEN RN

Provider Business Mailing Address
First Line	:	PO BOX 2352
Second Line	:
City	:	BUCKLEY
State	:	WA
Zip	:	98321-2352
Country	:	US
Telephone Number	:	253-651-3232
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 2352
Second Line	:
City	:	BUCKLEY
State	:	WA
Zip	:	98321-2352
Country	:	US
Telephone Number	:	253-651-3232
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	03/09/2026

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