Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD00025634 | WA |
NPI | 1013062157 |
---|---|
Provider Name | Elsa Ann Johnson |
First Address | Seattle, WA 98124-1581 |
Second Address | Seattle, WA 98112-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 04/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8153025 | (05) | WA |
E81324 | (02) | WA |