Individual
MARISA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1303 LINE AVE, STE 400, SHREVEPORT, LA 71101-4628
(318) 221-2707
(313) 221-2709
Mailing address
1303 LINE AVE, STE 400, SHREVEPORT, LA 71101-4628
(318) 221-2707
(313) 221-2709
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
023908
LA
207RN0300X
Nephrology Physician
L6967
TX
207RN0300X
Nephrology Physician
Primary
MD.023908
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146986802
—
TX
05
—
1487481
—
LA
Enumeration date
08/09/2005
Last updated
09/06/2017
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