Provider Demographics
NPI:1063410181
Name:JOHNSON, ROSA M (ARNP, MN)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 N NORTHGATE WAY
Mailing Address - Street 2:STE 217
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8419
Mailing Address - Country:US
Mailing Address - Phone:206-367-0550
Mailing Address - Fax:206-363-2550
Practice Address - Street 1:2111 N NORTHGATE WAY
Practice Address - Street 2:STE 217
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9018
Practice Address - Country:US
Practice Address - Phone:206-367-0550
Practice Address - Fax:206-363-2550
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB02377Medicare ID - Type Unspecified
WAAB02377Medicare UPIN