Individual
NICOLE RENEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1338 COMMERCE AVE STE 303, LONGVIEW, WA 98632-3726
(360) 261-6930
Mailing address
PO BOX 1447, CHEHALIS, WA 98532-0378
(360) 261-6930
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG60971822
WA
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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