Provider Demographics
NPI:1427361690
Name:JOHNSON, STEPHANIE L (NNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 N. GANTENBEIN AVE.
Mailing Address - Street 2:NICU
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1623
Mailing Address - Country:US
Mailing Address - Phone:503-413-2304
Mailing Address - Fax:503-413-2145
Practice Address - Street 1:2801 N GANTENBEIN AVE
Practice Address - Street 2:NICU
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1623
Practice Address - Country:US
Practice Address - Phone:503-413-2304
Practice Address - Fax:503-413-2145
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050065363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal