Provider Demographics
NPI:1417000308
Name:JOHNSON, RAQUEL DEE (CNM)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:DEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 SW 4TH AVE
Mailing Address - Street 2:SUITE2
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-4566
Mailing Address - Country:US
Mailing Address - Phone:541-889-2229
Mailing Address - Fax:541-889-4378
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:SUITE2
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-4566
Practice Address - Country:US
Practice Address - Phone:541-889-2229
Practice Address - Fax:541-889-4378
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200750055NP NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife