Individual
JUSTINE JOHANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
200743173RN
OR
163W00000X
Registered Nurse
RN60092547
WA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
RN60092547
WA
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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