Provider Demographics
NPI:1982242012
Name:JOHNSON, JANICE RICH IX
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:RICH
Last Name:JOHNSON
Suffix:IX
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 SHETLER RD
Mailing Address - Street 2:
Mailing Address - City:ARIEL
Mailing Address - State:WA
Mailing Address - Zip Code:98603-9792
Mailing Address - Country:US
Mailing Address - Phone:360-231-4251
Mailing Address - Fax:
Practice Address - Street 1:181 SHETLER RD
Practice Address - Street 2:
Practice Address - City:ARIEL
Practice Address - State:WA
Practice Address - Zip Code:98603-9792
Practice Address - Country:US
Practice Address - Phone:360-231-4251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider