Provider Demographics
NPI:1922735901
Name:JOHNSON, MATTHEW RYAN (ARNP, RN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RYAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:ARNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53A PETES RETREAT RD
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:WA
Mailing Address - Zip Code:99166-9541
Mailing Address - Country:US
Mailing Address - Phone:425-268-3587
Mailing Address - Fax:
Practice Address - Street 1:10 ROS CIR
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:WA
Practice Address - Zip Code:99166-5002
Practice Address - Country:US
Practice Address - Phone:509-775-3153
Practice Address - Fax:509-775-8929
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60972676163W00000X
WAAP61351549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse