Provider Demographics
NPI:1487103362
Name:NGUYEN-JOHNSON, ALEXANDRIA
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:NGUYEN-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15548 SW WINTERGREEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2616
Mailing Address - Country:US
Mailing Address - Phone:541-543-4413
Mailing Address - Fax:503-213-6330
Practice Address - Street 1:10110 SW NIMBUS AVE STE B2
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4359
Practice Address - Country:US
Practice Address - Phone:971-213-5775
Practice Address - Fax:503-213-6330
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC183990171100000X
OR4012175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500753165Medicaid
OR500753160Medicaid