Provider Demographics
NPI:1316060817
Name:JOHNSON, ANN MARIE (LAC, RN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:NEOTSU
Mailing Address - State:OR
Mailing Address - Zip Code:97364-0926
Mailing Address - Country:US
Mailing Address - Phone:541-994-8191
Mailing Address - Fax:
Practice Address - Street 1:4783 SW HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:LINCOLN CITY
Practice Address - State:OR
Practice Address - Zip Code:97367-1564
Practice Address - Country:US
Practice Address - Phone:541-994-1819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00838171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist