Provider Demographics
NPI:1740390582
Name:MAEHREN, JOHNETTE BARNES (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHNETTE
Middle Name:BARNES
Last Name:MAEHREN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SOUTH J. STREET
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-426-6076
Mailing Address - Fax:253-426-6954
Practice Address - Street 1:1717 SOUTH J. STREET
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-426-6076
Practice Address - Fax:253-426-6954
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8160764Medicaid
WAAB14198Medicare ID - Type Unspecified
WA8160764Medicaid