MRS. JOHANNA RAE PETERSON (NPI# 1396934238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396934238 |
| Entity Type | Individual |
| Full Name | MRS. JOHANNA RAE PETERSON |
| Other Name | JOHANNA RAE GODELL |
| Credential | PA-C |
| Practice Address |
400 Hickory St Nw Ste 303 Albany OR 97321-1700 |
| Mailing Address |
Po Box 1188 Corvallis OR 97339-1188 |
| Practice Telephone | 5418125275 |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2020-11-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA01280 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134481831 | Johanna Suzanne Peterson | Dermatology | 3901 Rainbow Blvd. 6040 Delp, Ms1020, Division of General and Geriatric Medicine, University, Kansas City, KS 66160-0001 | 2012-06-09 |
| 1861625766 | Johanna Peterson | Case Manager/Care Coordinator | 1900 10th St, Alamogordo, NM 88310-5053 | 2009-08-26 |
| Street Address |
400 HICKORY ST NW STE 303 |
| City | ALBANY |
| State | OR |
| Zip Code | 97321-1700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437112919 | Bruce Bohman | Emergency Medicine | 400 Hickory St Nw Ste 303, Albany, OR 97321-1700 | 2006-04-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730659228 | Waverly Assisted Living, LLC | In Home Supportive Care | 2853 Salem Ave Se Ste A, Albany, OR 97321 | 2018-11-28 |
| 1558838706 | Greater Albany Public Schools 8j | Local Education Agency (LEA) | 718 Seventh Ave. Sw, Albany, OR 97321 | 2018-10-25 |
| 1396232237 | Chiho Sakamoto Gunton | Social Worker | 227 Sw 3rd Avenue, Albany, OR 97321 | 2018-04-17 |
| 1700333184 | Albany General Hospital | Clinic/Center | 534 Pleasant View Way Nw, Suite 400, Albany, OR 97321 | 2016-09-02 |
| 1811373772 | Katrin M Ridge | Pharmacist | 1010 7th Ave. Sw., Albany, OR 97321 | 2015-08-03 |
| 1720485527 | Heartsong Counseling | Counselor | 425 Sw 2nd Ave. #203, Albany, OR 97321 | 2014-11-24 |
| 1619386604 | Courtney Ann Miller | Dentist | 2815 Willetta St, Suite A-1, Albany, OR 97321 | 2014-08-05 |
| 1346664810 | Jeffrey Othniel Nordtvedt | Case Manager/Care Coordinator | 2730 Sw Pacific Boulevard, Albany, OR 97321 | 2014-02-05 |
| 1174872022 | Albany General Hospital | Internal Medicine | 631 Southwest Elm Street, Suite 200, Albany, OR 97321 | 2012-09-06 |
| 1144594532 | Russell Travis | Pharmacist | 1177 Waverly Dr, Albany, OR 97321 | 2012-03-02 |
| Find all providers in zip 97321 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922489384 | Jessica Patrizio | Physician Assistant | 25 Hackett Blvd # Mc69, Albany, NY 12208-3462 | 2015-06-11 |
| 1952799611 | Tezita Beemnet | Physician Assistant | 1712 E Broad Ave # Setc, Albany, GA 31705-2611 | 2015-01-05 |
| 1437485257 | Rebecca M Hosey | Physician Assistant | 116 Everett Road, Medical Pain Management Services, Pllc, Albany, NY 12205-1427 | 2009-10-29 |
| 1124185590 | Christine Elizabeth Mcgovern | Physician Assistant | 1400 Washington Ave, University Health Center, Albany, NY 12222-0100 | 2007-01-03 |
| 1508893157 | Cheryl J Perog | Physician Assistant | St. Peter's Hospitoal Occupational Health, 310 South Manning Boulevard, Albany, NY 12053 | 2006-06-27 |
| 1598744534 | Richard H Stowe Jr. | Physician Assistant | 425 W 3rd Ave Ste 550, Albany, GA 31701-1999 | 2006-01-10 |
| 1043218878 | John A Dennis | Physician Assistant | 1200 N Jefferson St, Albany, GA 31701-2057 | 2005-07-14 |
| 1265430326 | Dennis I. Silber | Physician Assistant | 2 Palisades Drive, Albany, NY 12205-1438 | 2005-07-12 |
| 1700496635 | Angela Cunningham | Physician Assistant | 43 New Scotland Ave, Albany, NY 12208-3412 | 2020-08-05 |
| 1629619846 | Daniel A Horton | Physician Assistant | 123 Everett Rd, Albany, NY 12205-1407 | 2019-09-30 |
| Find all providers in ALBANY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.