Provider Demographics
NPI:1386258697
Name:EKDAHL-JOHNSON, TERESA JO (ARNP, FNP-C)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JO
Last Name:EKDAHL-JOHNSON
Suffix:
Gender:
Credentials:ARNP, FNP-C
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 2429
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8486
Mailing Address - Country:US
Mailing Address - Phone:360-353-9494
Mailing Address - Fax:360-353-9440
Practice Address - Street 1:1044 11TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2506
Practice Address - Country:US
Practice Address - Phone:360-353-9494
Practice Address - Fax:360-353-9440
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61095075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AP61095075OtherWA ARNP LICENSE