Individual
CAROL EILEEN JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 E COLUMBIA AVE, COLVILLE, WA 99114-3354
(509) 684-3701
(509) 684-5817
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61293717
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2019
Last updated
07/27/2023
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