Provider Demographics
NPI:1083864045
Name:JOHNSON, REBECCA E (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 E ROWAN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1202
Mailing Address - Country:US
Mailing Address - Phone:509-489-3554
Mailing Address - Fax:509-232-4387
Practice Address - Street 1:220 E ROWAN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1202
Practice Address - Country:US
Practice Address - Phone:509-489-3554
Practice Address - Fax:509-232-4387
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8528036Medicaid
WAG887979Medicare PIN