Provider Demographics
NPI:1811465180
Name:JOHNSON, GINA MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 NE 4TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5175
Mailing Address - Country:US
Mailing Address - Phone:425-998-9561
Mailing Address - Fax:
Practice Address - Street 1:10400 NE 4TH ST STE 500
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5175
Practice Address - Country:US
Practice Address - Phone:425-998-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60905890175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath