Individual
SHANA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
344 CLEVELAND AVE SE STE C, TUMWATER, WA 98501-3342
(360) 464-7940
(360) 362-8749
Mailing address
344 CLEVELAND AVE SE STE C, TUMWATER, WA 98501-3342
(360) 464-7940
(360) 362-8749
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD 60001063
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0241237
L&I
WA
05
—
8521783
—
WA
01
—
BP1-0022479
INSTITUTIONAL PERMIT
—
01
—
MD 60001063
MEDICAL LICENSE
WA
Enumeration date
06/11/2007
Last updated
08/11/2020
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