Basic Information
| Provider Information | |||||||||
| NPI: | 1154559342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | TERRA | ||||||||
| MiddleName: | DIANE | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16045 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069654100 | ||||||||
| FaxNumber: | 2069654119 | ||||||||
| Practice Location | |||||||||
| Address1: | 16045 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981481401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069654100 | ||||||||
| FaxNumber: | 2069654119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 10/03/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00167659 | WA | N | Nursing Service Providers | Registered Nurse | 363LA2200X | AP60094436 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.