Individual
SANDRA P. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
525 MADRONA ST, PORT ORFORD, OR 97465-9552
(541) 332-3861
(541) 332-0250
Mailing address
94220 4TH ST, GOLD BEACH, OR 97444-7756
(541) 332-3861
(541) 332-0250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200550082NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
276235
CURRY FAMILY MEDICAL MEDICAID
OR
05
—
276235
—
OR
01
—
38-3990
CURRY FAMILY MEDICAL RHC
OR
01
—
93-0937095
CURRY HEALTH DISTRICT TAX ID
OR
Enumeration date
06/22/2006
Last updated
06/07/2009
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