Individual
PHYLLIS C JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
209 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4265
(253) 596-3300
Mailing address
PO BOX 34581, SEATTLE, WA 98124-1581
(509) 241-7349
(509) 241-7628
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA10001989
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8357071
—
WA
Enumeration date
02/16/2007
Last updated
04/01/2009
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