Provider Demographics
NPI:1699196139
Name:JOHNSON, HEATHER J (CNM - ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM - ARNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:EWOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:560 GAGE BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:945 GOETHALS DRIVE, STE 200
Practice Address - Street 2:KADLEC CLINIC ASSOCIATED PHYSICIANS FOR WOMEN
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-942-2555
Practice Address - Fax:509-942-2340
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60595031367A00000X
OR201392779RN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife