Doctor Name: | GINA MARIE JOHNSON |
NPI Number: | 1053616441 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT 17789 |
License Number: | LMT 17789 |
Business Practice Address: | 2077 Nw Town Center Dr Beaverton, OR - 970068938 |
Business Phone Number: | 5035977780 |
Business Fax Number: | |
Mailing Address: | 2077 Nw Town Center Dr, BEAVERTON |
State: | OR |
Postal Code: | 970068938 |
Phone Number: | 5035977780 |
Fax Number: | |
NPI Enumeration Date: | 01/17/2011 |
NPI Last Update Date: | 09/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | LMT 17789 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |