Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | MD17446 | OR |
Y | 207VG0400X | Gynecologist | MD60287595 | WA |
NPI | 1073546925 |
---|---|
Provider Name | Dr. Susan H. Johnson |
First Address | Federal Way, WA 98003-8726 |
Second Address | Federal Way, WA 98003-8726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 12/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0296298 | STATE L&I (01) | WA |
160059803 | RAILROAD MEDICARE (01) | OR |
8145617 | (05) | OR |
F05542 | (02) | OR |