Provider Demographics
NPI:1447435854
Name:JOHNSON, ANDREW LOREN (MERCHANT CORPSMAN)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LOREN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MERCHANT CORPSMAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W. HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119
Mailing Address - Country:US
Mailing Address - Phone:206-286-8584
Mailing Address - Fax:203-346-6592
Practice Address - Street 1:111 W. HARRISON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119
Practice Address - Country:US
Practice Address - Phone:206-286-8584
Practice Address - Fax:203-346-6592
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXB0305588146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic