Provider Demographics
NPI:1982666129
Name:JOHNSON, WILLIAM J JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:TILLAMOOK
Mailing Address - State:OR
Mailing Address - Zip Code:97141
Mailing Address - Country:US
Mailing Address - Phone:503-842-3900
Mailing Address - Fax:503-842-3903
Practice Address - Street 1:111 SOUTH MILLER
Practice Address - Street 2:SUITE C E F
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:OR
Practice Address - Zip Code:97136
Practice Address - Country:US
Practice Address - Phone:503-355-2700
Practice Address - Fax:503-355-2702
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
R116497Medicare ID - Type Unspecified
R13882Medicare UPIN