Basic Information
| Provider Information | |||||||||
| NPI: | 1528572088 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | NATHANIEL | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSN, APRN, NNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2233 NW 58TH ST UNIT 211 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981076102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454176852 | ||||||||
| FaxNumber: | 8454176852 | ||||||||
| Practice Location | |||||||||
| Address1: | 4800 SAND POINT WAY NE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981053901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069872000 | ||||||||
| FaxNumber: | 2069872000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2017 | ||||||||
| LastUpdateDate: | 11/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0002X | RN60769449 | WA | N | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care | 363LN0005X | AP60811289 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal, Critical Care |
ID Information
| ID | Type | State | Issuer | Description | AP60811289 | 01 | WA | WASHINGTON STATE DEPARTMENT OF HEALTH | OTHER |