Provider Demographics
NPI:1891205126
Name:JOHNSON, RAJEANA K (DNP, AGNP-C, APRN)
Entity Type:Individual
Prefix:DR
First Name:RAJEANA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, AGNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 S GROUSE MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-7519
Mailing Address - Country:US
Mailing Address - Phone:360-464-0599
Mailing Address - Fax:
Practice Address - Street 1:22820 E APPLEWAY AVE STE C
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5214
Practice Address - Country:US
Practice Address - Phone:509-755-4971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61364364363LG0600X
HIAPRN-2327363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology