Individual
JENNIFER JOHNSON CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1905 SE 164TH AVE, VANCOUVER, WA 98683-8937
(360) 836-3396
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
200750023NP
OR
363LF0000X
Family Nurse Practitioner
Primary
AP30007648
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500601300
—
OR
05
—
9658154
—
WA
Enumeration date
08/13/2007
Last updated
02/20/2017
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