Provider Demographics
NPI:1154956720
Name:JOHNSON, ARLENE (DNP, CNM, ARNP)
Entity type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, CNM, ARNP
Other - Prefix:
Other - First Name:ARLENE
Other - Middle Name:
Other - Last Name:AMADOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4267
Mailing Address - Country:US
Mailing Address - Phone:253-596-3300
Mailing Address - Fax:253-596-3301
Practice Address - Street 1:20696 BOND RD NE UNIT C
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9015
Practice Address - Country:US
Practice Address - Phone:360-779-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60192159163WX0003X
WAAP61163082367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, InpatientGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2223252Medicaid