Provider Demographics
NPI:1376007286
Name:JOHNSON, FRITZINA FAY (CPCAAC)
Entity Type:Individual
Prefix:
First Name:FRITZINA
Middle Name:FAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPCAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 WESTERN AVE APT 1004
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2041
Mailing Address - Country:US
Mailing Address - Phone:206-769-8381
Mailing Address - Fax:
Practice Address - Street 1:1420 WESTERN AVE APT 1004
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2041
Practice Address - Country:US
Practice Address - Phone:206-769-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist