Individual
MS. SUSAN RUTH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
91 SW CHEHALIS AVE STE 101, CHEHALIS, WA 98532-1934
(360) 740-5181
(360) 740-6007
Mailing address
PO BOX 1883, YELM, WA 98597-1883
(360) 894-0256
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10005035
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215145
L AND I
WA
Enumeration date
11/22/2006
Last updated
07/08/2007
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