Individual
MS. FARLAND IDE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7734 SE 66TH PL, PORTLAND, OR 97206-9658
(971) 404-5634
Mailing address
7734 SE 66TH PL, PORTLAND, OR 97206-9658
(971) 404-5634
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
11138
OR
Other
Enumeration date
06/03/2009
Last updated
06/03/2009
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