Provider Demographics
NPI:1528572088
Name:JOHNSON, NATHANIEL THOMAS (MSN, APRN, NNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MSN, APRN, NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 NW 58TH ST UNIT 211
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-6102
Mailing Address - Country:US
Mailing Address - Phone:845-417-6852
Mailing Address - Fax:845-417-6852
Practice Address - Street 1:4800 SAND POINT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3901
Practice Address - Country:US
Practice Address - Phone:206-987-2000
Practice Address - Fax:206-987-2000
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60769449163WN0002X
WAAP60811289363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60811289OtherWASHINGTON STATE DEPARTMENT OF HEALTH