Provider Demographics
NPI:1851373799
Name:JOHNSON, LAURA SCHELLENBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:SCHELLENBERG
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:CHRISTINE
Other - Last Name:SCHELLENBERG-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12040 NE 128TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3013
Mailing Address - Country:US
Mailing Address - Phone:425-899-1040
Mailing Address - Fax:
Practice Address - Street 1:12040 NE 128TH ST # MS 105
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2560
Practice Address - Fax:425-899-2079
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043961207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA200320OtherLABOR & INDUSTRIES
WAG8903731Medicare PIN
WAI41629Medicare UPIN
WA8856122Medicare ID - Type Unspecified