Individual
KIMBERLY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1330 COMMERCIAL ST SE, SALEM, OR 97302-4206
(503) 763-1973
Mailing address
2670 SUNRISE AVE S, SALEM, OR 97302-5480
(541) 968-8325
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201242475RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201242475RN
OREGON STATE BOARD OF NURSING
OR
Enumeration date
12/17/2015
Last updated
12/17/2015
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