Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 18917 | CA |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 4484 | OR |
NPI | 1033159082 |
---|---|
Provider Name | Jennifer Lee Johnson |
First Address | Hillsboro, OR 97123-4246 |
Second Address | Hillsboro, OR 97123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 10/03/2014 |