Provider Demographics
NPI:1851891139
Name:JOHNSON, ANDREA MAYA (LM, CPM, MA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MAYA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LM, CPM, MA
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MAYA
Other - Last Name:ODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13236 111TH CT NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-5306
Mailing Address - Country:US
Mailing Address - Phone:206-240-9238
Mailing Address - Fax:
Practice Address - Street 1:13236 111TH CT NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-5306
Practice Address - Country:US
Practice Address - Phone:206-240-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60805661176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife