Provider Demographics
NPI:1518072107
Name:JOHNSEN, NATALIA ALEXANDROVNA (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIA
Middle Name:ALEXANDROVNA
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NATALIA
Other - Middle Name:ALEXANDROVNA
Other - Last Name:KOUZNETSOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:709 NE 136TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6922
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044661207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine