Individual
MR. ROBERT JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
529 JASMINE ST, OMAK, WA 98841-9589
(509) 826-1600
Mailing address
529 JASMINE ST, OMAK, WA 98841-9589
(509) 826-1600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA60248541
WA
363AM0700X
Medical Physician Assistant
PA60248541
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639452618
—
WA
Enumeration date
09/26/2011
Last updated
09/10/2015
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