Doctor Name: | RACHEL JOHANSON |
NPI Number: | 1215136817 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN, CNM, WHNP |
License Number: | 17533A |
Business Practice Address: | 36 Professional Plaza Ste. 204 Rexburg, ID - 834402049 |
Business Phone Number: | 2083560234 |
Business Fax Number: | |
Mailing Address: | 36 Professional Plaza Ste. 204, REXBURG |
State: | ID |
Postal Code: | 834402049 |
Phone Number: | 2083560234 |
Fax Number: | |
NPI Enumeration Date: | 07/13/2007 |
NPI Last Update Date: | 10/27/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LW0102X |
License Number: | 17533A |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ID |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Women's Health |
Taxonomy Definition: |