Individual
WAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
2401 BRISTOL CT SW, SUITE A-103, OLYMPIA, WA 98502-6003
(360) 878-7506
Mailing address
2401 BRISTOL CT SW, SUITE A-103, OLYMPIA, WA 98502-6003
(360) 350-0015
(360) 350-0019
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00024292
WA
Other
Enumeration date
06/08/2009
Last updated
06/08/2009
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