Provider Demographics
NPI:1295130979
Name:JOHNSEN, NICOLE KATRINA (ARNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KATRINA
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 108TH AVE NE
Mailing Address - Street 2:OVERLAKE MEDICAL CLINIC, DOWNTOWN BELLEVUE
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-635-6350
Mailing Address - Fax:
Practice Address - Street 1:400 108TH AVE NE
Practice Address - Street 2:OVERLAKE MEDICAL CLINIC, DOWNTOWN BELLEVUE
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-635-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60508856363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care