Provider Demographics
NPI:1598048167
Name:JOHNSON, DIANA MARIE (RN, QMRP, CHSP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, QMRP, CHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-2339
Mailing Address - Country:US
Mailing Address - Phone:541-767-3693
Mailing Address - Fax:541-767-3693
Practice Address - Street 1:495 S 16TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2339
Practice Address - Country:US
Practice Address - Phone:541-767-3693
Practice Address - Fax:541-767-3693
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000178RN163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health