Provider Demographics
NPI:1164491148
Name:JOHANNES, DONNA L (ANP, GNP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:ANP, GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 SW WHISPER CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5010
Mailing Address - Country:US
Mailing Address - Phone:503-215-3602
Mailing Address - Fax:503-215-6942
Practice Address - Street 1:4540 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2333
Practice Address - Country:US
Practice Address - Phone:503-215-3602
Practice Address - Fax:503-215-6942
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000037597N3 ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health