Individual
IVY JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3305 SUNSHINE PL, KLAMATH FALLS, OR 97603-7059
(530) 774-0285
Mailing address
3305 SUNSHINE PL, KLAMATH FALLS, OR 97603-7059
(530) 774-0285
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
10025020
OR
Other
Enumeration date
12/01/2021
Last updated
10/07/2025
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