Provider Demographics
NPI:1992888234
Name:ROSA M JOHNSON, ARNP, MN, PS, INC
Entity type:Organization
Organization Name:ROSA M JOHNSON, ARNP, MN, PS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-367-0550
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:STE 307
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-367-0550
Mailing Address - Fax:206-368-1128
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:STE 307
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-367-0550
Practice Address - Fax:206-368-1128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAS45845Medicare UPIN
WA8858827Medicare ID - Type Unspecified