Individual
DR. MARYJAYNE MABREY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
6190 N SUNSHINE ST STE E, COEUR D ALENE, ID 83815-8697
(208) 719-0311
(208) 719-0301
Mailing address
6190 N SUNSHINE ST STE E, COEUR D ALENE, ID 83815-8697
(208) 719-0311
(208) 719-0301
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1871154
ID
363LF0000X
Family Nurse Practitioner
197104-4405
UT
363LF0000X
Family Nurse Practitioner
95026427
CA
363LF0000X
Family Nurse Practitioner
APT0007476
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225123888
—
WA
01
—
P01522254
RR PTAN
WA
Enumeration date
10/03/2006
Last updated
04/23/2026
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