Individual
NICHOLLE LEIGH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7621 N PORTSMOUTH AVE, PORTLAND, OR 97203-5953
(503) 240-7599
Mailing address
715 N BLANDENA ST, PORTLAND, OR 97217-2620
(503) 249-2977
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
OR
Other
Enumeration date
01/28/2007
Last updated
07/08/2007
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