Provider Demographics
NPI:1518726751
Name:JOHNSON, LAMARR RENEE
Entity Type:Individual
Prefix:
First Name:LAMARR
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 N JACKSON AVE APT B37
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-8455
Mailing Address - Country:US
Mailing Address - Phone:253-876-4080
Mailing Address - Fax:
Practice Address - Street 1:5915 ORCHARD ST W
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467-3824
Practice Address - Country:US
Practice Address - Phone:253-414-7461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program