Individual
MS. NICOLE KATHLEEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, APRN, CRNA
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
4415 SE YAMHILL ST, PORTLAND, OR 97215-2461
(386) 747-9222
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10034882
OR
Other
Enumeration date
01/16/2025
Last updated
01/16/2025
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