Individual provider · Type 1 NPI

Brett Johansen, PA-C

Medical Physician Assistant · Fruitland, ID

NPI number 1982074696 Active

Practice location

1210 NW 16th St
Fruitland, ID 83619-2202

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700XPA-1308 (ID)

Medical Physician Assistant: Definition to come...

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About NPI 1982074696

Brett Johansen, PA-C's National Provider Identifier is 1982074696, issued on Oct 7, 2015. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Fruitland, ID. The record was last updated on Oct 7, 2015.